The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

A Survey on Transfusion Status in Orthopedic Surgery at a Trauma Center

Document Type : RESEARCH PAPER

Authors
Mehran Soleimanha 1
mohammad haghighi 2
Ahmadreza Mirbolook 1
Abbas Sedighinejad 2
Mohsen Mardani-kivi 1
Bahram Naderi-nabi 2
Tahereh Chavoshi 2
Mehrnoosh Ghandili Mehrnoosh 1
1 Orthopaedic Research Center, Guilan University of Medical Sciences, Rasht, Iran
2 Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran
10.22038/abjs.2016.5820
Abstract
 
Background: Increased costs and mortality associated with inappropriate blood transfusions have led to investigations about blood request and blood transfusion techniques. We investigated the transfusion status in patients who underwent orthopedic surgery in Poursina Hospital (Rasht, Iran) to optimizing blood usage and determine if a scheduled transfusion program for every orthopedic surgery could improve blood transfusion management.

Method: In this descriptive-prospective study, all orthopedic surgeries in Poursina Hospital, Rasht, between April to June 2013 were reviewed. All patient information was recorded, including: demographics, type of surgery, hemoglobin level, cross-match test, duration of surgery, and blood loss, and transfusion. Based on the one-way ANOVA and independent samples test analysis, cross-match to transfusion ratio and transfusion possibility, the transfusion index, and maximal surgical blood order schedule were calculated to determine blood transfusion status.

Results: Among 872 selected orthopedic surgery candidates, 318 of them were cross-matched and among those, 114 patients received a blood transfusion. In this study, the cross-match to transfusion ratio was 6.4, transfusion possibility 36.47%, transfusion index 0.6, and maximal surgical blood order schedule 0.9.

Conclusion: We found that blood ordering was moderately higher than the standard; so it is highly recommended to focus on the knowledge of evidence based on transfusion and standard guidelines for blood transfusion to avoid over-ordering.
Keywords
Blood transfusion
Orthopedic surgery
Transfusion index
Transfusion possibility
  1. Basnet R, Lamichhane D, Sharma VK. A study of blood requisition and transfusion practice in surgery at Bir Hospital. Post Med J NAMS. 2009; 9(2):14-9.
  2. Waqas M, Shamim MS, Ujjan B, Bakhshi SK. Prospective validation of a blood ordering protocol for elective spine arthrodesis and its impact on cost reduction. Surg Neurol Int. 2014; 5(Suppl 7):S362-4.
  3. Jayaranee S, Prathiba R, Vasanthi N, Lopez CG. An analysis of blood utilization for elective surgery in a tertiary medical centre in Malaysia. Malays J Pathol. 2002; 24(1):59-66.
  4. Peivandi Yazdi A, Alipoor M, Jahanbakhsh SS, Gharavifard M, Taghavi M. A survey of blood request versus blood utilization at a university hospital in Iran. Arch Bone Joint Surg. 2015; In Press.
  5. Shimizu K, Muroi K, Imai M, Asano K, Tamura M, Imai S. New blood transfusion system of the Saku Central Hospital--present conditions and problems. Masui. 2003; 52(9):1021-5.
  6. Bhutia SG, Srinivasan K, Ananthakrishnan N, Jayanthi S, Ravishankar M. Blood utilization in elective surgery--requirements, ordering and transfusion practices. Natl Med J India. 1997; 10(4):164-8.
  7. Kajja I, Bimenya GS, Eindhoven GB, ten Duis HJ, Sibinga CT. Surgical blood order equation in femoral fracture surgery. Transfus Med. 2011; 21(1):7-12.
  8. Lim EJ, Lopez CG, Veera SN, Menaka N, Aminah A. Efficiency of blood usage for elective surgery in the University Hospital Kuala Lumpur. Malays J Pathol. 1996; 18(2):107-12.
  9. Mead JH, Anthony CD, Sattler M. Hemotherapy in elective surgery: an incidence report, review of the literature, and alternatives for guideline appraisal. Am J Clin Pathol. 1980; 74(2):223-7.
  10. Belayneh T, Messele G, Abdissa Z, Tegene B. Blood requisition and utilization practice in surgical patients at university of gondar hospital, northwest ethiopia. J Blood Transfus. 2013; 2013(10):1-5.
  11. Khoshrang H, Madani AH, Roshan ZA, Ramezanzadeh MS. Survey on blood ordering and utilisation patterns in elective urological surgery. Blood Transfus. 2013; 11(1):123-7.
  12. Subramanian A, Sagar S, Kumar S, Agrawal D, Albert V, Misra MC. Maximum surgical blood ordering schedule in a tertiary trauma center in northern India: A proposal. J Emerg Trauma Shock. 2012; 5(4):321-7.
  13. Ayantunde AA, Ng MY, Pal S, Welch NT, Parsons SL. Analysis of blood transfusion predictors in patients undergoing elective oesophagectomy for cancer. BMC Surg. 2008; 8(1):3-10.
  14. Vibhute M, Kamath SK, Shetty A. Blood utilisation in elective general surgery cases: requirements, ordering and transfusion practices. J Postgrad Med. 2000; 46(1):13-7.
  15. Mahar FK, Moiz B, Khurshid M, Chawla T. Implementation of maximum surgical blood ordering schedule and an improvement in transfusion practices of surgeons subsequent to intervention. Indian J Hematol Blood Transfus. 2013; 29(3):129-33.
  16. Foley CL, Mould T, Kennedy J, Barton DP. A study of blood cross-matching requirements for surgery in gynecological oncology: Improved efficiency and cost saving. Int J Gynecol Cancer. 2003; 13(6):889-93.
  17. Hall TC, Pattenden C, Hollobone C, Pollard C, Dennison AR. Blood transfusion policies in elective general surgery: how to optimise cross-match-to-transfusion ratios. Transfus Med Hemother. 2013; 40(1):27-31.
  18. Singh JK, Singh P. Routine pre-operative cross-match for elective colorectal resections: an appropriate use of resources? Surgeon. 2011; 9(1):8-12.
  19. Kuehn BM. Guideline tightens transfusion criteria. JAMA. 2012; 307(17):1788-9.
The Archives of Bone and Joint Surgery
Volume 4, Issue 1 - Serial Number 1
January 2016
Pages 70-74

  • Receive Date 27 April 2015
  • Revise Date 13 November 2015
  • Accept Date 22 November 2015