An Evidence-Based Best Practice Perioperative Matrix Eliminates Allogenic Blood Transfusions in Simultaneous Bilateral Total Knee Replacements (Preprint)

Abstract

Simultaneous bilateral total knee replacements (SBTKR) are associated with increased blood loss and a higher transfusion rate. Blood transfusions post total knee replacement increase infection rates, length of stay and costs to the healthcare system.

The purpose of this study was to evaluate the effect of an evidence-based perioperative matrix on allogenic blood transfusions in patients undergoing SBTKR.

A retrospective analysis was performed on a consecutive series of patients who underwent SBTKR by a single surgeon utilizing evidence-based preoperative, intraoperative and postoperative strategies to reduce the need for blood transfusions. Patients had serial haemoglobins days one to three post-operatively to identify percentage drop. A transfusion threshold of 70g/l Hb or a symptomatic patient were used. Subgroup analysis of patients on aspirin preoperatively was performed.

There were 168 consecutive patients with a mean age of 65 ± 7 years. No patients required a transfusion following surgery. One patient was readmitted for a transfusion after a gastrointestinal bleed. Percentage blood loss did not correlate with age, BMI or sex. There was a correlation between preoperative haemoglobin and percentage haemoglobin drop day one (P<0.001) and day two (P=0.003). Percentage Hb drop was no greater in patients taking a cardiac dose of aspirin pre-operatively (P=0.48).

An evidence-based best practice perioperative matrix may eliminate the need for blood transfusion in optimised patients undergoing simultaneous bilateral total knee replacements.