Low Transfusion Rate Attainable in Anterior Approach Total Hip Arthroplasty Utilizing a Modern Protocol

Joseph S. Gondusky, Benjamin C. Campbell, C. Coulson
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Abstract

Background: Transfusion is a known risk of total hip arthroplasty (THA). It has been associated with a multitude of medical complications and increased cost. Prior studies report transfusion rates associated with THA, with wide variation, but most cannot differentiate the surgical approach utilized. The anterior approach (AA) for THA has been associated with increased operative time, complications, and blood loss, but little data exists regarding the actual transfusion rate associated with the approach. Methods: We performed a retrospective review of 390 consecutive, elective, primary unilateral AA THA procedures. Patient demographic, clinical and perioperative data was analyzed. A modern perioperative pathway, including a simple protocol to limit blood loss, is defined. Results: The group consisted of a typical inpatient arthroplasty population, with wide ranges of age, body mass index (BMI), and health status. The average age was 64.05 years (+ 10.67, range 27-94). BMI averaged 29.76 kg/m2 (+ 5.98, range 16-47). The majority of patients were American Society of Anesthesiologists (ASA) class 2 (45.6%) or 3 (50.3%), with 10 patients ASA 4 (2.6%). Average preoperative hemoglobin was 13.48 g/dL (+ 1.47, range 9.118.2). Operative time averaged 91.22 minutes (+ 14.2). 83.3% of patients received a spinal anesthetic. Most patients were discharged on postoperative day one (93.1%) to home (99%). Estimated blood loss averaged 264mL (+ 95.19, range 100-1000). No patient required perioperative transfusion or readmission for symptomatic anemia within 30 days postoperative. Conclusion: A modern protocol we utilize and define is capable of limiting blood loss and transfusion risk in anterior approach total hip arthroplasty.
采用现代方案的前路全髋关节置换术可达到低输血率
背景:输血是已知的全髋关节置换术(THA)的风险。它与许多医疗并发症和增加的成本有关。先前的研究报告了与THA相关的输血率,差异很大,但大多数无法区分所使用的手术方法。THA的前路入路(AA)与手术时间、并发症和失血增加有关,但关于与该入路相关的实际输血率的数据很少。方法:我们对390例连续、选择性、原发性单侧AA THA手术进行了回顾性分析。对患者人口统计学、临床和围手术期数据进行分析。定义了一种现代围手术期途径,包括一种限制失血的简单方案。结果:该组由典型的关节成形术住院人群组成,年龄、体重指数(BMI)和健康状况各不相同。平均年龄64.05岁(+10.67,范围27-94)。BMI平均为29.76 kg/m2(+5.98,范围16-47)。大多数患者为美国麻醉师协会(ASA)2级(45.6%)或3级(50.3%),其中10名患者ASA 4级(2.6%)。术前平均血红蛋白为13.48 g/dL(+1.47,范围9.118.2)。手术时间平均为91.22分钟(+14.2)。83.3%的患者接受了脊椎麻醉。大多数患者在术后第一天(93.1%)出院回家(99%)。估计的平均失血量为264毫升(+95.19,范围100-1000)。术后30天内,无患者因症状性贫血需要围手术期输血或再次入院。结论:我们使用和定义的现代方案能够限制全髋关节置换术前入路的失血和输血风险。
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2
审稿时长
24 weeks
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