Abstract
Objective Preoperative anemia in orthopedic patients is associated with higher allogeneic blood
transfusion rates and poorer outcomes. Up to 25% of the patients listed for major
orthopedic surgery have some degree of anemia. Good perioperative patient blood management
is essential to reduce the sequelae of anemia and the need for transfusions. We assessed
the efficacy of rapid near-patient testing in conjunction with a dedicated preoperative
anemia clinic for screening and treating primary total hip replacement (THR) patients
for anemia.
Methods A comparison of overall allogeneic blood transfusion rates was made for patients
undergoing primary total hip replacement before and after the implementation of near-patient
testing and of a dedicated preoperative anemia clinic over 1 year. A comparison was
also performed between anemic patients who were referred to the clinic with those
who were not referred. Preoperative hemoglobin levels, allogeneic blood transfusion
rates and clinic treatment for 1,095 patients were reviewed.
Results There was a significant decrease in transfusion rates in patients undergoing primary
THR from 10.0 to 6.2% (p < 0.05; χ2 test) after the implementation of near-patient testing and of a dedicated
preoperative anemia clinic pathway. The allogeneic blood transfusion rate for anemic
patients who were treated in the clinic was 6.7% compared with 26.9% for patients
who were anemic preoperatively but were not treated in the clinic (p < 0.05; Fisher exact test). On average, treatment in the pathway increased the hemoglobin
of the patients by 20 g/L, from 104 g/L to 124 g/L (p < 0.001).
Conclusions Near-patient testing, in conjunction with a dedicated preoperative anemia clinic,
reduces perioperative allogenic blood transfusion requirements for patients undergoing
primary THR by providing rapid identification and effective treatment of preoperative
anemia.
Keywords blood transfusion - anemia - arthroplasty, replacement, hip - preoperative period
