Blood Transfusion Rate and Related Complications after Hip Arthroplasty Using Patient Blood Management: A Case-Control Study.

Abstract

Background: This study aimed to compare the rates of blood transfusion and blood loss after hip arthroplasty using patient blood management (PBM). In addition, we investigated the occurrence of hypophosphatemia after injection of iron supplement with intravenous ferric carboxymaltose.

Methods: Between March 2022 and February 2023, 233 patients underwent total hip arthroplasty or hemiarthroplasty with the application of PBM, including 95 men and 138 women with a mean age at the time of index operation of 62.7 years (range, 21-100 years). A control group of 466 patients treated between 2010 and 2019 was identified based on propensity score matching (1 : 2) including matching for age ± 3 years, sex, and diagnosis (disease or fracture). We compared changes in hemoglobin (Hb) levels, transfusion rate, blood loss, and prevalence of hypophosphatemia before and after the PBM protocol.

Results: The PBM group had a significantly lower intraoperative blood loss (mean, 116 mL vs. 268 mL, p < 0.001) and transfusion rate (15% vs. 41%, p < 0.001) than the control group. Preoperative mean Hb level was 13.23 g/dL for the PBM group and 12.64 g/dL for the control group. Postoperative day 2 mean Hb level in the PBM group was significantly higer than that of the control group (12.37 ± 1.82 g/dL vs. 9.87 ± 1.44 g/dL, p < 0.001). The preoperative incidence of hypophosphatemia was 3.5% and increased to 23% postoperatively. Two weeks after surgery, the incidence of hypophosphatemia decreased to 7.1%, and there were no complications due to hypophosphatemia during hospitalization.

Conclusions: This study demonstrated that the PBM program for hip joint arthroplasty reduced the rates of blood transfusion and blood loss. Therefore, PBM may be positively associated with improved clinical outcomes.