Effectiveness of a blood transfusion guideline in major orthopaedic surgery

Background: Major orthopedic surgery often requires allogeneic blood transfusion that involves a risk for infection and other complications. The decision to transfuse is typically at the surgeon’s discretion. Objective: To evaluate the effect of a blood transfusion guideline on allogeneic transfusion rates, volumes and outcomes in patients with major orthopedic surgery. Materials and Methods: Data were collected retrospectively in 115 patients before implementing a guideline (pre-guideline group), and prospectively in 115 patients to whom a guideline defining criteria for red cell transfusion was applied (guideline group). The guideline for packed red cell transfusion was a hematocrit <25% or a hemoglobin of <8 g/dL. These thresholds were disregarded if the clinical situation warranted it. Clinical data and post-operative outcomes were recorded and compared. Results: The two groups were not significantly different with respect to age, sex, BMI, ASA classification, pre-operative cHb/Hct level, operative time and intraoperative blood loss. In the pre-guideline group, 45 (39.1%) patients received transfusion compared to 22 (19.1%) in the guideline group (p = 0.001). Patients in the pre-guideline group received more transfusion (0.68+1.02 units) than the guideline group (0.24+0.68 units). Mean difference of blood transfusion between two groups, 0.48 units (95% CI 0.23 to 0.73), was statistically significant (p<0.001). There were no significant differences in outcome. Conclusion: A transfusion guideline using hematocrit and hemoglobin thresholds reduced the frequency and volume of allogeneic blood transfusions without increasing postoperative complications in patients with major orthopedic surgery.