Appropriateness of red blood cell use in orthopedic surgery and traumatology: analysis of transfusion practice

Introduction and purpose The need for perioperative patient blood management measures aiming at improving patient outcomes and reducing the need for transfusion is increasingly recognized. This study determines to what degree the utilization of packed red blood cells (PRBCs) is appropriate in orthopedic and trauma surgery and identiWes the factors that lead to inappropriate transfusion practice. Materials and methods This is an observational, retrospective study including patients who had undergone orthopedic or trauma surgery and received at least one unit of PRBCs during the study period. To assess the appropriateness of transfusion, an algorithm was developed to establish the decision pathway to classify the transfusion episodes as appropriate/inappropriate. The main assessment criterion was the percentage of appropriate transfusion episodes according to the established transfusion criteria. Results During a period of one year, 384 patients were included in the study. Mean hemoglobin value at admittance was 12.1 g/dl (95% CI; 11.6–12.7). The most frequent type of surgery was total hip replacement (35%). A mean of 2.72 (95% CI, 2.06–3.38) PRBC units were transfused per patient. Among the 384 transfusion episodes analyzed, 288 (75%) were appropriate and 96 (25%) were inappropriate. A total of 775 allogeneic units were appropriately transfused (78.8%), whereas only 80 of the autologous units (63%) were transfused adhering to the established transfusion criteria (P < 000.1). Patients with appropriate transfusion had a mean age 9.9 years higher than those with inappropriate transfusion (P < 0.0001). Conclusions In 75% of PRBC units transfused in orthopedic and trauma surgery, transfusion was appropriate. Nevertheless, additional eVorts are needed to improve this practice. Education tool for physicians would help to prevent unnecessary transfusions.