Restrictive transfusion strategy in orthopedics surgery

Abstract

Major orthopedic surgery is the surgical solution proposed for patients who suffer from advanced arthrosis or for some cases of hip fracture. Some of these patients will require blood and/or blood components transfusion before or after surgery.
The approach to anemia in surgical patients may involve a liberal or a restrictive transfusion strategy, according to what each surgeon indicates, or observing the context of a restrictive protocol for blood replacement.
The latter results in resource savings and in a reduction in the number of complications due to the administration of allogenic blood.
The study aims to compare the liberal transfusion strategy to the restrictive strategy. 498 patients were included in the study, 261 of which (52.4%) were treated within the liberal strategy in 2014, and 237 (47.6%) were treated according to a restrictive transfusion protocol in 2015. A smaller number of individuals received blood transfusions and 55% less blood volumes were needed when the restrictive strategy was applied.
Ten cases of transfusion reaction arose, all of them involving fever, 8 in 2014 and 2 in 2015. As to the functional evolution, no differences were found between the two groups.
According to our study, and according to the global literature consulted, the restrictive therapy strategy enables the same functional results with a lower risk for patients, and it saves resources for the system.