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Blood Preservation: Who Stands to Benefit from Intraoperative Blood Salvage?
e76 The Journal of Arthroplasty Vol. 25 No. 3 April 2010
Poster #31 Blood Preservation: Who Stands to Benefit from Intraoperative Blood Salvage? Ian Pawasarat, MA, Matthew DeStefano, BS, Megan Morris, BS, Camilo Restrepo, MD, Javad Parvizi, MD, FRCS, Peter F. Sharkey, MD, William J. Hozack, MD, Richard H. Rothman, MD, PhD Introduction: Despite anesthesia and surgical improvements, significant blood loss during revision total joint arthroplasty still occurs. These procedures routinely result in an increased requirement for allogenic transfusion which is associated with potential risks. Intraoperative blood salvage is one method of minimizing these risks, albeit an expensive one. The goal of the current retrospective analysis was to determine the group of revision patients who will benefit most from the use of IOBS. Material and Methods: After institutional review board approval, a query was done of our transfusion database for all patients having undergone revision total hip arthroplasty, identifying 1495 patients between 2000 and 2007. Charts were reviewed for type of IOBS, estimated blood loss, number of allogenic and autologous transfusions, pre- and postoperative laboratory values, patient demographics, length of surgery, and cause of revision. Analyses were conducted to determine patient and surgical characteristics associated with increased blood loss. Results: Analysis revealed a correlation between revised components, complexity, and length of revision, with estimated and calculated blood loss, and reinfusion of salvaged blood. We found that only a little over half of the aseptic patients for whom IOBS was available endured a procedure in which enough blood was shed to be viable for return, a clear waste of resources. Discussion: Suggesting that the nonselective use of IOBS for all hip revision arthroplasty is associated with low yield. As we continue our entrance into an era in which the importance of getting the most “bang for the buck” is ever increasing, it is necessary in medicine to spend more wisely, as the age old adage of “whatever is best for the patient” is no longer valid. To make IOBS more cost effective, it should be reserved for the more complex surgical cases with an expected operative time exceeding 2 hours and expected blood loss greater than 300 mL.
Poster #31 Blood Preservation: Who Stands to Benefit from Intraoperative Blood Salvage? Ian Pawasarat, MA, Matthew DeStefano, BS, Megan Morris, BS, Camilo Restrepo, MD, Javad Parvizi, MD, FRCS, Peter F. Sharkey, MD, William J. Hozack, MD, Richard H. Rothman, MD, PhD Introduction: Despite anesthesia and surgical improvements, significant blood loss during revision total joint arthroplasty still occurs. These procedures routinely result in an increased requirement for allogenic transfusion which is associated with potential risks. Intraoperative blood salvage is one method of minimizing these risks, albeit an expensive one. The goal of the current retrospective analysis was to determine the group of revision patients who will benefit most from the use of IOBS. Material and Methods: After institutional review board approval, a query was done of our transfusion database for all patients having undergone revision total hip arthroplasty, identifying 1495 patients between 2000 and 2007. Charts were reviewed for type of IOBS, estimated blood loss, number of allogenic and autologous transfusions, pre- and postoperative laboratory values, patient demographics, length of surgery, and cause of revision. Analyses were conducted to determine patient and surgical characteristics associated with increased blood loss. Results: Analysis revealed a correlation between revised components, complexity, and length of revision, with estimated and calculated blood loss, and reinfusion of salvaged blood. We found that only a little over half of the aseptic patients for whom IOBS was available endured a procedure in which enough blood was shed to be viable for return, a clear waste of resources. Discussion: Suggesting that the nonselective use of IOBS for all hip revision arthroplasty is associated with low yield. As we continue our entrance into an era in which the importance of getting the most “bang for the buck” is ever increasing, it is necessary in medicine to spend more wisely, as the age old adage of “whatever is best for the patient” is no longer valid. To make IOBS more cost effective, it should be reserved for the more complex surgical cases with an expected operative time exceeding 2 hours and expected blood loss greater than 300 mL.