Predicrors for Postoperative Blood Transfusion requirement in Primary TKA
Keywords:
การผ่าตัดเปลี่ยนข้อเข่า, การสูญเสียเลือดจากการผ่าตัด, การได้รับเลือดทดแทนAbstract
Blood loss in patients underwent total joint arthroplasty can be substantial. Studies demonstrated that blood loss can approximate 1500 ml. for a primary joint arthroplasty. The result of blood loss witch led to the consequence impacts and often necessitates transfusions. Determining of predictive factors may provide information on reduction the incidence of transfusion and improving quality of care study design: Retrospective cohort study. Setting: Department of orthopedics surgery, Lamphun Hospital Method: 73 patients underwent primary TKA between April and September 2009. The outcomes of interest was the incidence of the patients received allogeneic blood transfusion after surgery, and the related predictive factors. Differences between blood transfusion and non-blood transfusion group were analyzed by chi-square test and t-test. Predictive factors were evaluated by univariate log risk regression and 95% CI. The independence effect of predictive factors were analyzed using multivariate log risk regression model. Result: Predictive factors for blood transfusion requirement after primary TKA were Age ≥ 70yrs(RR=4.44, P=0.028), Operating time ≥ 91 mins(RR=11.33, P0.047), Tourniquet released to achieved hemostasis (RR=4.60,P=0.007), Tourniquet pressurc 400mmHg(RR=3.45, P=0.0280, Patella resurfacing(RR=2.76,P=0.033), and postoperative blood loss ≥ 801 ml.(RR=4.44,P=0.028) Among a variety of predictive factors, only tourniquet release to achieved hemostasis was consistently associated with blood transfusion requirement. (RR.15.46, P=0.024) Conclusion: In addition to patients’ age ≥ 70 yrs, operating time ≥ 91 mins, tourniquet release to achieved hemostasis, tourniquet pressure 400mmHg. Patella resurfacting, and postoperative blood loss ≥ 801ml. were important in predicting the requirement for blood transfusion after primary TKA procedure. Surveillance should be focus on these patients. And tourniquet released to achieved hemostasis may not an effective tool in reducing perioperative blood loss.
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