Audit of Blood Transfusion in Primary Knee and Hip Arthroplasty at the National Orthopaedic Hospital, Enugu. Nigeria

Abstract

Background: Total joint arthroplasty (TJA) is accompanied by considerable blood loss and red cell transfusion. With increasing concern regarding the adverse outcomes associated with allogeneic blood transfusion we set out to evaluate our current practice by determining the incidence, type and pattern of red cell transfusion in our arthroplasty patients and ascertain the predictors of perioperative blood transfusion.
Patients and Methods: We conducted a retrospective study and enrolled patients that had elective primary unilateral total knee arthroplasty or total hip arthroplasty at our healthcare facility between January, 2010 and December, 2019. Relevant information regarding patients demographic, clinical and red cell transfusion data were extracted from operating room records, patient's folders and anaesthetic charts. We performed bivariate analysis and multivariate logistic regression analysis to determine the predictors of blood transfusion. Statistical significance level was set at P
value <0.05.
Results: The cohort comprised 153 patients with mean age of 55.2±13.5years. Preoperative anaemia was present in 42.5% (65/153) of the patients and the transfusion rate was 60.1% (92/153). Only half (6/12) of the HbSS patients received preoperative blood transfusion. Predonated autologous blood constituted 2% (4/198) of total red cell units transfused. The predictors of perioperative red cell transfusion were the presence of preoperative anaemia (AOR; 2.2, 95% CI; 1.1-4.5) and having knee arthroplasty (AOR; 0.3, 95% CI; 0.1- 0.7).
Conclusion: This audit revealed that there was remarkable potential for reducing allogeneic blood transfusion and this could be achieved through the correction of preoperative anaemia in the patients and enhanced use of predonated autologous blood.

Keywords: Arthroplasty, autologous, allogeneic, anaemia, patient blood management