Blood transfusion in major artroplasties: Frequency, causes and investigation of transfusion effect on outcome Majör artroplastilerde kan transfüzyonu: Siklik, nedenler ve transfüzyonun iyileşme üzerindeki etkisinin araştirilmasi
Anestezi Dergisi, cilt.26, sa.3, ss.148-158, 2018 (Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 26 Sayı: 3
- Basım Tarihi: 2018
- Dergi Adı: Anestezi Dergisi
- Derginin Tarandığı İndeksler: Scopus, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.148-158
- Anahtar Kelimeler: Blood transfusion, Major artroplasty
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: To investigate the transfusion rates, transfusion indications and the effect of blood transfusions on recovery after major artroplasty. Method: Patients undergoing hip and knee arthroplasty at Diskapi Yildirim Beyazit Training and Research Hospital between July-December 2017 were evaluated with a prospective observational cross sectional study design. Data concerning patient, anesthesia and surgical characteristics, hemoglobin-hematocritplatelet values before and after transfusion, coagulation test results, transfusion indications, postoperative mobilization time and discharge time were recorded. Pediatric and pregnant patients were excluded. Data were compared between transfused and non-transfused patient groups and multiple regression analysis was performed to explore the factors with the strongest association with blood transfusion and the effect of transfusion on recovery as defined with mobilization delay and prolonged length of stay (PLOS). Results: During the study period 418 patients were evaluated; 330 female and 88 male and 281 of them underwent knee arthroplasty and 137 hip arthroplasty. The perioperative rate of blood transfusion was 28.2%, (n: 95) [4.8% (n:20) preoperative; 4.5% (n:19) intraoperative; 19.9% (n:83) postoperative].The transfusion indications were anemia and bleeding in the preoperative period; the amount of bleeding, hypotension, low hemoglobin value, hyperlactatemia, presence of comorbidities in the intraoperative period and low hemoglobin value, presence of comorbidities and the amount of bleeding in the postoperative period respectively. Multivariate analysis revealed that the risk of receiving blood transfusion increased with preoperative anemia (OR: 9.34, [%95 CI 0.056-0.204]), not using tranexamic acid (OR: 3.63, [%95 CI 1.556-8.47]), presence of comorbidities (OR: 2.76, [%95 CI 1.39-5.46]), not using tourniquet (OR: 2.54, [%95 CI 1.121-5.78]), increased amount of bleeding (OR: 1.002, [%95 CI 1.001-0.004]). The amount of bleeding was an independent risk factor for delayed postoperative mobilization at the 1st, 2nd and 3rd days and Plos (OR: 1.41 [%95 CI 1.127-1.77] OR: 1.42 [%95 CI 1.093-1.86]; (OR: 1.38 [%95 CI 1.171-1.645]); (OR: 1.32 [%95 CI 1.064-1.63] respectively) and being transfused was an independent risk factor for PLOS (OR: 2.62 [ %95 CI 1.028-6.69]). Conclusion: The perioperative transfusion rate in patients undergoing arthroplasty in our hospital is 28.2%. The indications for transfusion are anemia, blood loss, the amount of blood loss, hypotension, hemoglobin trigger and the presence of comorbidities respectively. The presence of preoperative anemia and comorbidities, avoidance of tranexamic acid and tourniquet use, advanced age, increased surgery duration and amount of bleeding are the independent risk factors for transfusion in patient undergoing major arthroplasty. Transfusion itself and the amount of transfusion are independent risk factors for delayed recovery.