European Journal of Anaesthesiology

Original Article
(RD) Surgery

Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen

B. Borghi a1, A. Casati a2 and on behalf of the Rizzoli Study Group on Orthopaedic Anaesthesia
a1 Department of Anaesthesiology, IRCCS Rizzoli Orthopaedic Institute, Bologna
a2 Department of Anaesthesiology, IRCCS H San Raffaele, Via Olgettina 60-20132 Milan, Italy

Article author query
borghi b   [PubMed][Google Scholar] 
casati a   [PubMed][Google Scholar] 


The efficacy of an integrated autotransfusion regimen, including pre-donation and perioperative salvage of autologous blood, was prospectively evaluated in 2884 patients undergoing total hip (n=2016) or knee arthroplasty (n = 480), and hip revision (n = 388) with either balanced general, regional, or integrated epidural/general anaesthesia. Allogenic concentrated red blood cells were transfused in the presence of symptomatic anaemia or when haemoglobin concentration was < 6gdL−1 (10gdL−1 in patients affected by cerebrovascular or coronary artery disease) after all salvaged and pre-donated autologous blood had been transfused. A total of 278 patients (9.6%) received allogenic blood. Risk factors for allogenic blood transfusion were: preoperative haemoglobin concentration < 10gdL−1 (after autologous blood pre-donations) (Odds ratio: 8.7; 95% CI: 6.5–16.8; P=0.004), hip revision versus hip or knee arthroplasty (Odds ratio: 5.8; 95% CI: 3.9–8.5; P=0.0001) and inability in obtaining the number of predonations required by the Maximum Surgery Blood Order on Schedule (Odds ratio: 3.4; 95% CI: 2.7–4.1; P=0.0001). The incidence of perioperative complications, including wound infection and haematoma, as well as myocardial ischaemia, respiratory failure and thromboembolic complications, was higher in those patients requiring allogenic blood transfusion (29.8%) than that observed in patients receiving only autologous blood (6.6%) (P=0.0005); while the mean time duration from surgical procedure to patient discharge from the orthopaedic ward was shorter in those patients not receiving allogenic blood transfusion (12 days; 25–75th percentiles: 8–14 days) than in those patients who required perioperative transfusion with allogenic blood (15 days; 25–75th percentiles: 10–17 days) (P=0.0005). In conclusion, this prospective study highlighted the clinical relevance of applying an extensive and integrated autotransfusion regimen in order to reduce allogenic blood transfusion and associated complications in patients undergoing major joint replacement.

(Published Online August 16 2006)
(Accepted March 2000)

Key Words: blood transfusion; autologous; anaesthesia general; conduction; local; specialties; surgical; orthopaedics; orthopaedic procedures; arthroplasty; arthroplasty replacement; replacement; hip; knee.