An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery

被引:40
作者
Slappendel, R [1 ]
Dirksen, R
Weber, EWG
van der Schaaf, DB
机构
[1] Sint Maartensklin, Dept Anaesthesiol, Nijmegen, Netherlands
[2] Sint Maartensklin, Dept Orthoped, Nijmegen, Netherlands
[3] Acad Hosp Maastricht, Dept Anaesthesiol, Maastricht, Netherlands
来源
ACTA ORTHOPAEDICA SCANDINAVICA | 2003年 / 74卷 / 05期
关键词
D O I
10.1080/00016470310017974
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
In a previous prospective study, we confirmed that transfusion-related immunosuppression predisposes to postoperative infections, impairs the postoperative healing of wound and thereby prolongs hospitalization. This increases the well-known risks, such as transmission of infection or transfusion reactions, and has obliged us to revise our transfusion guidelines. We used a relational database containing information about 28,861 orthopedic surgery patients was used to determine when and how to improve these guidelines for transfusions. The survey showed the circumstances surrounding a high incidence of allogenic red cell infusions: failure to follow the guidelines, the preoperative use of nonselective NSAIDs, low preoperative Hb level, failure to retrieve blood, and high cut-off values for allogenic red cell transfusion. The first step was to determine the Hb level before giving red cell infusions and ensure compliance with predefined cut-off values. Subsequent measures included: use of COX 2-selective NSAIDs alone in the perioperative period; erythropoietin and iron therapy when the Hb level fell below 13 g/dL; use of cell salvage during and after surgery; administration of aprotinin to patients expected to have a high blood loss. The type of anesthesia had no blood-sparing effect. Although these steps can not be regarded as a new approach, we show that by following a strict rules with appropriate steps and in a concerted fashion, the use of allogenic red blood cells was reduced by 80%. Moreover, the amount of blood saved had other effects-e.g., the incidence of deep wound infections was reduced by 40%. The outcome is described in an algorithm sum-marizing the steps in a comprehensive perioperative diagram for giving blood.
引用
收藏
页码:569 / 575
页数:7
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