A transfusion medicine physician in Denmark reports that as part of their ongoing audits of blood usage during 2004, they studied blood usage associated with total hip replacements. A total of 856 "first time" and "redo" hip replacements were included in their study, covering 4 hospitals. The blood usage was recorded from day of surgery to day of discharge. The usage did not seem alarming with 25 - 37 % of patients being transfused in the "first time" hip replacement group and 48 - 57 % being transfused in the "redo" group. Transfused patients in the "first time" hip replacement group received an average of 2.93 units of RBC, while the transfused patients in the "redo" group received an average of 3.68 units of RBC. The Denmark physician wonders if there is consensus as to bench-mark RBC usage in these kinds of operations.

The following comments have been received.

ADDENDA July 25, 2005

1. A transfusion medicine physician in Ohio reports that his hospital's Transfusion Review Committee has tracked blood loss for many surgical procedure, including hip surgeries. They did a two year analysis of blood utilization by hip surgery and used 2.6 units of RBCs for primary hip surgeries and 3.8 units for redo hip surgeries. He believes that the adoption of blood conservation can reduce this blood usage to near zero.

ADDENDA July 26, 2005

2. A transfusion medicine physician comments that regarding transfusion utilization in total hip arthroplasty, he would strongly recommend interested parties to read Pierson, J et al. A Blood-Conservation Algorithm to Reduce Blood Transfusions After Total Hip and Knee Arthroplasty. Journal of Bone and Joint Surg 2004; 86A(7):1512-18. Using a standard algorithm, the authors demonstrated a 2.8% transfusion rate in primary total hip arthroplasty. A primary intervention was a conservative transfusion trigger.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator