Journal of Surgery

Role of Restrictive Transfusion Strategy on Post-Operative Complication and Prosperity of Thai Patients upon Total Knee Replacement

Abstract

Vongtawan Juntavee, Viroj Larbpaiboonpong and Ukrit Chaweewannakorn

Introduction: Blood transfusions have been reported to cause post-operative complications. Despite the protocols being conducted to minimize the utilization of blood transfusion and improve the standard of care in blood transfusion strategy, there is no consensus on transfusion indication threshold.
Objectives: This study assessed the effect and complication using a new restrictive blood transfusion strategy threshold in patients undergoing total knee replacement.
Materials and methods: This study performed observational evaluation on the proportion of patients to be transfused with the new restrictive blood transfusion strategy (Hb level below 8 g/dL and/or presence of symptoms of anemia) and compared post-operative symptoms of transfused patients to un-transfused patients, who underwent total knee surgery at Police General Hospital. A total of 120 patients were studied. Patients’ demographics, peri-operative parameter, and post-operative symptoms in conjunction with length of hospitalization were compared between groups. Statistics was determined for each parameter and analyzed using Student’s t-test, Pearson’s chi-square test, Fisher’s exact test, and odd ratio at 95% confidence level.
Results: Of 120 patients, 12 patients (10%) were transfused. The post-operative complications including cardiovascular, respiratory, gastrointestinal, infection, and other symptoms did not differ significantly between transfused and un-transfused patients (p>0.05), except that there was more neuropsychiatric symptom in the un-transfused group than the transfused group (in 16.3% vs. 1.6% of patients; 95% CI 1.43-101.97), whereas the length of hospital stay was not different between groups (p>0.05). Blood utilization reduction with the new transfusion strategy was 74 units.
Conclusion: Among patients undergoing total knee replacement, most patients with hemoglobin level 8-10 g/dL were tolerant to the new transfusion strategy (90.24%). Further, post-operative symptoms were not significantly higher between transfused and un-transfused patients. Also, as in the aforementioned study, the new transfusion strategy is considered relatively safe and can be effective as a blood conservative algorithm.