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Hoffmann, R. A wiki for the life sciences where authorship matters. Nature Genetics (2008)
 
 
 

Do we really need to routinely crossmatch blood before primary total knee or hip arthroplasty?

BACKGROUND: A maximum surgical blood ordering schedule may lead to wastage of valuable resources due to over-ordering of blood and/or under-utilisation. We audited the results of a group-and-save (GS) policy for primary hip (THR) and knee ( TKR) arthroplasty to evaluate its safety and practicality. PATIENTS AND METHODS: We conducted a retrospective review of consecutive patients attending for THR (177) or TKR (137) over a period of 8 months (phase 1). Following introduction of a limited GS policy, 205 THR and 147 TKR were reviewed prospectively over a corresponding period of 8 months (phase 2). Corresponding THR and TKR groups in each phase were comparable with respect to age, gender, length of stay, operating surgeon, pre- and lowest postoperative hemoglobin, reason for and timing of transfusion. Quantities (units) of blood requested pre- and postoperatively, transfused and returned to the blood bank, were recorded. RESULTS: 77 and 62% of all blood requested for THR and TKR, respectively, in phase 1 was not used. 58 and 21% of patients undergoing THR and TKR, respectively, in phase 2 underwent preoperative GS, with 92% and 100% of all blood requested being used for transfusion. Overall, the quantity of blood returned was reduced by 25% for the THR group. Transfusion rates fell by 9% and 5% for the TKR and THR groups, respectively. We found no adverse events associated with blood from a GS sample. Cost savings of 37 800 euro were calculated estimated for the study period (phase 2). INTERPRETATION: For routine primary THR/ TKR, GS policy is a safe procedure. Reduction in non-utilisation of blood has economic and cost-saving implications for limited healthcare resources. Having subsequently introduced a group-and-save policy for all patients undergoing routine THR/ TKR, considerable savings have been identified after only 2 months.[1]

References

  1. Do we really need to routinely crossmatch blood before primary total knee or hip arthroplasty? Mundy, G.M., Hardiment, K., Revill, J., Birtwistle, S.J., Power, R.A. Acta orthopaedica Scandinavica. (2004) [Pubmed]
 
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