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Blood management of staged bilateral total knee arthroplasty in a single hospitalization period.

Ma J, Huang Z, Shen B, Pei F - J Orthop Surg Res (2014)

Bottom Line: Significant benefits were also found in Group A in terms of postoperative Hb and hematocrit (Hct), reduction of postoperative pain, swelling, postoperative pain, length of stays, and hospital costs.No deep vein thrombosis (DVT) events were found in all these patients.The newly introduced MBM in staged bilateral TKA in a single hospitalization period can reduce blood loss effectively as well as pain and knee joint swelling instead of leading to increased complications and result in significant cost savings.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu 610041, People's Republic of China. peifuxing1951@163.com.

ABSTRACT

Introduction: Few literatures have studied the blood management in patients treated with staged bilateral primary total knee arthroplasty (TKA) in a single hospitalization period. Therefore, this study aims to evaluate the effectiveness and safety of the newly introduced multimodal blood management (MBM) in these patients.

Materials and methods: We retrospectively compared the perioperative parameters in 70 cases undergoing staged bilateral primary TKA in a single hospitalization period from 2012-2013 in a single center with two different groups of patients, allocating cases to the group with the newly introduced MBM (Group A, n =33) and controls to the group without the newly introduced MBM (Group B, n =37). The newly introduced MBM protocols include preoperative hemoglobin (Hb) evaluation, high protein diet, tourniquet release after skin closure, preoperative oral iron treatment and femoral canal obturation, and one dose of tranexamic acid (TXA) IV with another one if necessary. While in the control group, only routine blood-saving techniques were used.

Results: Group A had a transfusion rate of 9% (3/33), whereas 32.4% of patients (12/37) in Group B received allogenic blood transfusion. Significant benefits were also found in Group A in terms of postoperative Hb and hematocrit (Hct), reduction of postoperative pain, swelling, postoperative pain, length of stays, and hospital costs. No deep vein thrombosis (DVT) events were found in all these patients.

Conclusions: The newly introduced MBM in staged bilateral TKA in a single hospitalization period can reduce blood loss effectively as well as pain and knee joint swelling instead of leading to increased complications and result in significant cost savings.

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Related in: MedlinePlus

The perioperative levels of hematocrits (Hct) at each time point.Pre OP preoperative, POH1(F) 1st hour after the first surgery, POD1(F) 1st day after the first surgery, POD3(F) 3rd day after the first surgery, POH1(S) 1st hour after the second surgery, POD1(S) 1st day after the second surgery, POD3(S) 3rd day after the second surgery. The asterisks indicate values that were significantly different between the groups.
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Fig2: The perioperative levels of hematocrits (Hct) at each time point.Pre OP preoperative, POH1(F) 1st hour after the first surgery, POD1(F) 1st day after the first surgery, POD3(F) 3rd day after the first surgery, POH1(S) 1st hour after the second surgery, POD1(S) 1st day after the second surgery, POD3(S) 3rd day after the second surgery. The asterisks indicate values that were significantly different between the groups.

Mentions: The patient demographics and clinical data were comparable between the two groups, as shown in Table 1. Both Hb and Hct levels in the two groups showed significant decreases postoperatively, and they both reached the lowest point on the postoperative day 3 of each surgery (Figures 1 and 2). The mean levels of Hb and Hct showed significant advantages in Group A at each time points postoperatively, compared with those in Group B, that is 123.6 ± 7.0 VS 120.3 ± 6.5 (p =0.04); 37.8 ± 1.7% VS 35.7 ± 1.9% (p <0.001) at 1 h after the first surgery (POH1(F)), 120.2 ± 7.2 VS 112.5 ± 5.8 (p <0.001); 37.8 ± 1.9% VS 35.7 ± 2.1% (p <0.001) on the 1st day after the first surgery (POD1(F)), 112.2 ± 6.6 VS 104.3 ± 6.3 (p <0.001); 35.6 ± 2.4% VS 32.8 ± 2.5% (p <0.001) on the 3rd day after the first surgery POD3(F), 107.6 ± 6.8 VS 98.7 ± 6.3 (p <0.001); 34.5 ± 2.7% VS 31.0 ± 2.5% (p >0.001) at 1 h after the second surgery (POH1(S)), 101.2 ± 7.3 VS 89.8 ± 6.2 (p <0.001); 31.2 ± 2.2% VS 27.7 ± 1.8% (p <0.001) on the 1st day after the second surgery (POD1(S)), 93.6 ± 5.6 VS 85.2 ± 4.0 (p <0.001); 28.7 ± 1.7% VS 25.1 ± 1.8% (p <0.001) on the 3rd day after the second surgery (POD3(S)) (Figures 1 and 2).Table 1


Blood management of staged bilateral total knee arthroplasty in a single hospitalization period.

Ma J, Huang Z, Shen B, Pei F - J Orthop Surg Res (2014)

The perioperative levels of hematocrits (Hct) at each time point.Pre OP preoperative, POH1(F) 1st hour after the first surgery, POD1(F) 1st day after the first surgery, POD3(F) 3rd day after the first surgery, POH1(S) 1st hour after the second surgery, POD1(S) 1st day after the second surgery, POD3(S) 3rd day after the second surgery. The asterisks indicate values that were significantly different between the groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4232703&req=5

Fig2: The perioperative levels of hematocrits (Hct) at each time point.Pre OP preoperative, POH1(F) 1st hour after the first surgery, POD1(F) 1st day after the first surgery, POD3(F) 3rd day after the first surgery, POH1(S) 1st hour after the second surgery, POD1(S) 1st day after the second surgery, POD3(S) 3rd day after the second surgery. The asterisks indicate values that were significantly different between the groups.
Mentions: The patient demographics and clinical data were comparable between the two groups, as shown in Table 1. Both Hb and Hct levels in the two groups showed significant decreases postoperatively, and they both reached the lowest point on the postoperative day 3 of each surgery (Figures 1 and 2). The mean levels of Hb and Hct showed significant advantages in Group A at each time points postoperatively, compared with those in Group B, that is 123.6 ± 7.0 VS 120.3 ± 6.5 (p =0.04); 37.8 ± 1.7% VS 35.7 ± 1.9% (p <0.001) at 1 h after the first surgery (POH1(F)), 120.2 ± 7.2 VS 112.5 ± 5.8 (p <0.001); 37.8 ± 1.9% VS 35.7 ± 2.1% (p <0.001) on the 1st day after the first surgery (POD1(F)), 112.2 ± 6.6 VS 104.3 ± 6.3 (p <0.001); 35.6 ± 2.4% VS 32.8 ± 2.5% (p <0.001) on the 3rd day after the first surgery POD3(F), 107.6 ± 6.8 VS 98.7 ± 6.3 (p <0.001); 34.5 ± 2.7% VS 31.0 ± 2.5% (p >0.001) at 1 h after the second surgery (POH1(S)), 101.2 ± 7.3 VS 89.8 ± 6.2 (p <0.001); 31.2 ± 2.2% VS 27.7 ± 1.8% (p <0.001) on the 1st day after the second surgery (POD1(S)), 93.6 ± 5.6 VS 85.2 ± 4.0 (p <0.001); 28.7 ± 1.7% VS 25.1 ± 1.8% (p <0.001) on the 3rd day after the second surgery (POD3(S)) (Figures 1 and 2).Table 1

Bottom Line: Significant benefits were also found in Group A in terms of postoperative Hb and hematocrit (Hct), reduction of postoperative pain, swelling, postoperative pain, length of stays, and hospital costs.No deep vein thrombosis (DVT) events were found in all these patients.The newly introduced MBM in staged bilateral TKA in a single hospitalization period can reduce blood loss effectively as well as pain and knee joint swelling instead of leading to increased complications and result in significant cost savings.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu 610041, People's Republic of China. peifuxing1951@163.com.

ABSTRACT

Introduction: Few literatures have studied the blood management in patients treated with staged bilateral primary total knee arthroplasty (TKA) in a single hospitalization period. Therefore, this study aims to evaluate the effectiveness and safety of the newly introduced multimodal blood management (MBM) in these patients.

Materials and methods: We retrospectively compared the perioperative parameters in 70 cases undergoing staged bilateral primary TKA in a single hospitalization period from 2012-2013 in a single center with two different groups of patients, allocating cases to the group with the newly introduced MBM (Group A, n =33) and controls to the group without the newly introduced MBM (Group B, n =37). The newly introduced MBM protocols include preoperative hemoglobin (Hb) evaluation, high protein diet, tourniquet release after skin closure, preoperative oral iron treatment and femoral canal obturation, and one dose of tranexamic acid (TXA) IV with another one if necessary. While in the control group, only routine blood-saving techniques were used.

Results: Group A had a transfusion rate of 9% (3/33), whereas 32.4% of patients (12/37) in Group B received allogenic blood transfusion. Significant benefits were also found in Group A in terms of postoperative Hb and hematocrit (Hct), reduction of postoperative pain, swelling, postoperative pain, length of stays, and hospital costs. No deep vein thrombosis (DVT) events were found in all these patients.

Conclusions: The newly introduced MBM in staged bilateral TKA in a single hospitalization period can reduce blood loss effectively as well as pain and knee joint swelling instead of leading to increased complications and result in significant cost savings.

Show MeSH
Related in: MedlinePlus