دورية أكاديمية
Reducing unnecessary crossmatching for hip fracture patients by accounting for preoperative hemoglobin concentration.
| العنوان: | Reducing unnecessary crossmatching for hip fracture patients by accounting for preoperative hemoglobin concentration. |
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| المؤلفون: | Amin RM; Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA 94305, United States., Puvanesarajah V; Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States., Chaudhry YP; Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19122, United States., Best MJ; Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MD 02114, United States., Rao SS; Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States., Frank SM; Department of Anesthesiology, Critical Care Medicine, Baltimore, MD 21205, United States., Hasenboehler EA; Department of Orthopaedics, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States. ehasenb1@jhmi.edu. |
| المصدر: | World journal of orthopedics [World J Orthop] 2021 May 18; Vol. 12 (5), pp. 292-300. Date of Electronic Publication: 2021 May 18 (Print Publication: 2021). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Baishideng Publishing Group Country of Publication: United States NLM ID: 101576349 Publication Model: eCollection Cited Medium: Print ISSN: 2218-5836 (Print) Linking ISSN: 22185836 NLM ISO Abbreviation: World J Orthop Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Publication: 2014-: Pleasanton, CA : Baishideng Publishing Group Original Publication: Hong Kong : Baishideng Publishing Group |
| مستخلص: | Background: Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources. Most protocols recommend type and cross of 2 red blood cell (RBC) units for patients undergoing surgery for treatment of hip fracture. Preoperative 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 surgery. Aim: To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion (C:T) ratio in hip fracture surgery patients. Methods: 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 disease. We 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 cohorts. Prediction profiling and sensitivity analysis were performed with statistical significance set at P < 0.05. Results: Four hundred and ninety-eight patients who underwent hip fracture surgery between 2013 and 2017 were identified, 291 in the post PBM cohort. Transfusion requirements in the post PBM cohort were lower (51% vs 33%, P < 0.0001) than in the pre PBM cohort. The 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 50% probability of requiring > 1 RBC unit was predicted by 11.2g/dL [AUC 0.80 (95%CI, 0.74-0.85), Sensitivity 0.87] in the pre PBM cohort and 8.7g/dL [AUC 0.78 (95%CI, 0.73-0.83), Sensitivity 0.84] in the post-PBM cohort. Conclusion: The hip fracture maximum surgical blood order schedule should consider preoperative hemoglobin in determining the number of units to type and cross prior to surgery. Competing Interests: Conflict-of-interest statement: Hasenboehler EA is a paid consultant for DePuy Synthes Trauma. He receives grant support as well as a grant for a research fellow from DePuy Synthes Trauma. He is also a paid lecturer and faculty for AO North America Trauma and has stock ownership in Summit Med Ventures. Other authors have no conflict-of-interest to disclose. (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.) |
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| فهرسة مساهمة: | Keywords: Blood conservation; Hemoglobin; Hip fracture; Maximum surgical blood order schedule; Transfusion; Type and cross |
| تواريخ الأحداث: | Date Created: 20210531 Latest Revision: 20210601 |
| رمز التحديث: | 20221213 |
| مُعرف محوري في PubMed: | PMC8152439 |
| DOI: | 10.5312/wjo.v12.i5.292 |
| PMID: | 34055586 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2218-5836 |
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| DOI: | 10.5312/wjo.v12.i5.292 |