An algorithm for predicting blood loss and transfusion risk after total hip arthroplasty |
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Authors: | Carlo Trevisan Raymond Klumpp Laura Auriemma Riccardo Compagnoni |
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Affiliation: | 1. Department of Orthopaedics and Traumatology, University of Milano-Bicocca, Italy;2. Department of Orthopaedics and Traumatology of the Hospital ASST Bergamo Est, Via Paderno 21, I-24068, Seriate, Bergamo, Italy;3. ASST Bergamo Est, Via Paderno 21, I-24068, Seriate, Bergamo, Italy;4. Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, I-20122, Milan, Italy;5. Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, I-20133, Milan, Italy |
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Abstract: | IntroductionPatients receiving blood transfusions after total hip arthroplasty have increased morbidity and longer lengths of stay compared to non-transfused patients. The aim of this study is to create an algorithm in order to identify patients at risk for transfusion after total hip replacement and define a safe point in hemoglobin levels after which the need for blood, transfusion can be excluded.MethodsThis retrospective study analyzed hemoglobin (Hb) levels for 5?days in patients undergoing total hip replacement. An algorithm was implemented to identify the critical trends of Hb levels in the first two postoperative days, trying to identify the patients at high risk of transfusion. Specificity, sensibility and efficiency were calculated in relation to the capability of the algorithm to correctly identify transfused patients.ResultsThe algorithm found a pre-operative Hb?≥?13?g/dl as a cut off between patients at low-risk or high-risk for transfusion. When parameters were calculated considering the best efficiency with the least number of false negatives, the algorithm showed a specificity of 84% and a sensitivity of 70% with an efficiency of 80.6%. Hb values?>10?g/dl in the first operative day for low-risk patients and Hb level?>?11?g/dl the second post-operative day for high-risk patients led to exclusion of the need for transfusion.ConclusionsThe algorithm suggested critical Hb levels to predict transfusion. In association with clinical data, the suggested critical values of Hb may be useful to schedule lab tests and a safe early discharge. |
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Keywords: | Algorithm Arthroplasty Blood Hip Transfusion |
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