Implementation of a restrictive transfusion protocol reduces the need for allogeneic blood transfusion in proximal humerus fracture repair without affecting patient outcome: preliminary observations

Abstract

SUMMARY Shoulder arthroplasty may be associated with considerable blood loss, and some patients require allogeneic blood transfusion (ABT). However, there is almost no information available for proximal humerus fracture (PHF) repair surgery. We therefore evaluated the influence of two transfusion protocols on ABT requirements in patients undergoing hemiarthroplasty surgery for PFH. We assessed the requirements for ABT in 78 patients receiving hemiarthroplasty for PHF, who were managed with a conservative transfusion protocol [hemoglobin(Hb) < 9.0 g/dL; group 1; n = 31] or a restrictive transfusion protocol (Hb < 8.0 g/dL and/or clinical signs/symptoms of anemia/hypoxemia; group 2; n = 47). Overall, the ABT rate (12% vs. 48%; P = 0.001) and the transfusion index (0.2 ± 0.7 vs. 0.9 ± 1.0 unit/patient; P = 0.001) were lower in group 2 than in group 1. The differences in transfusion rate and transfusion index between groups were significant for patients with Hb < 13.0 g/dL (75% vs. 18%, for groups 1 and 2, respectively; P = 0.001), but not for those with Hb ≥ 13.0 g/dL (20% vs. 7%; P = 0.180). The implementation of a restrictive transfusion protocol seems to be effective in reducing ABT, especially in PHF patients with preoperative Hb < 13.0 g/dL.