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Reducing unnecessary crossmatching for hip fracture patients by accounting for preoperative hemoglobin concentration

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World Journal of Orthopedics 2021年第5期12卷 292-300页

作者： Raj M Amin Varun Puvanesarajah Yash P Chaudhry Matthew J Best Sandesh S Rao Steven M Frank erik a hasenboehler Department of Orthopaedic Surgery Stanford University Medical CenterStanfordCA 94305United States Department of Orthopaedic Surgery Johns Hopkins School of MedicineBaltimoreMD 21205United States Department of Orthopaedic Surgery Philadelphia College of Osteopathic MedicinePhiladelphiaPA 19122United States Department of Orthopaedic Surgery Massachusetts General HospitalBostonMD 02114United States Department of Anesthesiology Critical Care MedicineBaltimoreMD 21205United States Department of Orthopaedics Johns Hopkins School of MedicineBaltimoreMD 21205United States

BACKGROUND Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank *** protocols recommend type and cross of 2 red blood cell(RBC)units for patients undergoing surgery for treatment of hip *** hemoglobin has been identified as the strongest predictor of inpatient transfusion,but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to *** To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion(C:T)ratio in hip fracture surgery *** In 2015 a patient blood management(PBM)program was implemented at our institution mandating a single unit-per-occurrence transfusion policy and a restrictive transfusion threshold of<7 g/dL hemoglobin in asymptomatic patients and<8 g/dL in those with refractory symptomatic anemia or history of coronary artery *** identified all hip fracture patients between 2013 and 2017 and compared the preoperative hemoglobin which would predict a 2:1 C:T ratio in the pre PBM and post PBM *** profiling and sensitivity analysis were performed with statistical significance set at P<*** Four hundred and ninety-eight patients who underwent hip fracture surgery between 2013 and 2017 were identified,291 in the post PBM *** requirements in the post PBM cohort were lower(51%vs 33%,P<0.0001)than in the pre PBM *** mean RBC units transfused per patient was 1.15 in the pre PBM cohort,compared to 0.66 in the post PBM cohort(P<0.001).The 2:1 C:T ratio(inpatient transfusion probability of 50%)was predicted by a preoperative hemoglobin of 12.3 g/dL[area under the curve(AUC)0.78(95%confidence interval(CI),0.72-0.83),Sensitivity 0.66]in the pre PBM cohort and 10.7 g/dL[AUC 0.78(95%CI,0.73-0.83),Sensitivity 0.88]in the post PBM cohort.A

关键词： Hip fracture Transfusion Blood conservation Hemoglobin Type and cross Maximum surgical blood order schedule

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