A Prospective, Randomized Study of Preoperative Autologous Donation for Hip Replacement Surgery

D. B. Billote, S. Glisson, D. Green, R. Wixson
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引用次数: 118

Abstract

Background: Preoperative autologous blood donation is commonly performed to meet potential perioperative transfusion needs and is a common practice prior to total hip arthroplasty. Using standardized transfusion guidelines, we prospectively analyzed the effectiveness of preoperative autologous donation as a method for decreasing allogeneic transfusion among patients undergoing unilateral primary total hip replacement who were eligible to donate autologous blood.Methods: Patients who were scheduled for primary total hip replacement surgery and who had a preoperative baseline hemoglobin level ≥120 g/L were randomized either to donate two units of blood (autologous donors) or not to donate any blood (nondonors). The donors and nondonors were compared with regard to demographic data, blood-loss volumes, hemoglobin measurements, and transfusion rates. Randomization continued until data were obtained from at least forty patients per treatment group.Results: Of the ninety-six patients who completed the study, forty-two were autologous donors and fifty-four were nondonors. There were no significant differences between the donors and nondonors with regard to age, male:female ratio, estimated blood volume, baseline physical condition, or operative blood loss. The hemoglobin values at the time of enrollment (baseline), at the time of hospital discharge, and six weeks postoperatively were not significantly different between the two groups, although values at the time of admission (129 ± 13 g/L versus 138 ± 12 g/L) and in the recovery room (104 ± 12 g/L versus 115 ± 13 g/L) were significantly lower in the autologous donor group (p < 0.05). No patient in either group required an allogeneic transfusion. Twenty-nine (69%) of the forty-two donors received an autologous transfusion. Thirty-four (41%) of eighty-two autologous units were wasted. At a charge of $379 per autologous unit, there was an additional cost of $758 for each patient in the donor group.Conclusions: Preoperative autologous donation provided no benefit for nonanemic patients undergoing primary total hip replacement surgery. Preoperative autologous donation increased the likelihood of autologous transfusion, wastage of predonated units, and costs.
髋关节置换术术前自体捐献的前瞻性随机研究
背景:术前自体献血通常是为了满足围手术期潜在的输血需求,也是全髋关节置换术前的常见做法。采用标准化输血指南,我们前瞻性地分析了术前自体捐献作为一种减少单侧原发性全髋关节置换术患者异体输血的方法的有效性,这些患者有资格捐献自体血液。方法:术前基线血红蛋白水平≥120 g/L且计划进行原发性全髋关节置换术的患者随机分为两组,一组献血2单位(自体献血者),另一组不献血(非献血者)。对献血者和非献血者进行人口统计数据、失血量、血红蛋白测量和输血率的比较。随机化继续进行,直到每个治疗组至少获得40例患者的数据。结果:在完成研究的96名患者中,42名是自体供体,54名是非供体。献血者和非献血者在年龄、男女比例、估计血容量、基线身体状况或手术出血量方面没有显著差异。两组患者入组时(基线)、出院时和术后6周的血红蛋白值无显著差异,但自体供体组入院时(129±13 g/L vs 138±12 g/L)和恢复室(104±12 g/L vs 115±13 g/L)的血红蛋白值明显低于自体供体组(p < 0.05)。两组均无患者需要异体输血。42名献血者中有29名(69%)接受了自体输血。在82个自体单位中有34个(41%)被浪费。每个自体单位的费用为379美元,而供体组的每位患者的额外费用为758美元。结论:术前自体捐献对接受原发性全髋关节置换术的非贫血患者无益处。术前自体捐献增加了自体输血的可能性、预先捐献单位的浪费和成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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