Effect of Comprehensive and Whole Process Blood Management on Allogeneic Transfusion in Orthopedic Surgical Patients

  Objective  To retrospectively analyze the effect of comprehensive and whole process blood management on allogeneic transfusion in patients undergoing orthopedic surgery.

  Methods  A total of 7082 patients (3320 in 2013, 3762 in 2014) who underwent orthopedic surgery in the period from January 2013 to December 2014 in Department of Orthopedics, Peking Union Medical College Hospital were retrospectively analyzed, among which 2178 cases in 2013 and 2322 cases in 2014 were considered at high hemorrhage risk. Since January 2014, the Department has implemented individualized comprehensive blood management measures covering the whole perioperative period, involving perioperative autologous blood transfusion technology, treatment improvement during surgery and perioperative period, drug intervention, and strict following of blood transfusion principles. We compared the overall conditions of allogeneic blood transfusion in 2014 with those in 2013, assessing the impact of those new management measures on allogeneic blood transfusion in patients who underwent orthopaedic surgery.

  Results  The differences in gender, age, types and distribution of high hemorrhage risk surgeries were not statistically significant between the two years. However, both the overall number of orthopedic surgeries and the number of surgeries with high hemorrhage risk were larger in 2014 than in 2013. The total volume of allogeneic blood transfusion in 2014 was 106 950 ml (713 cases), lower than the volume in 2013 (121 600 ml, 760 cases). Similarly, the total amount of transfused concentrated red blood cells in 2014 (2543 U) was less than that in 2013(2804 U). The expense on allogeneic transfusion was 680 720 RMB in 2014, accounting for 0.97% of the total medical expenses (70 287 242.03 RMB) of the patients receiving allogeneic blood transfusion and 0.35% of the overall medical expenses (196 100 485 RMB), which were all lower than the corresponding figures in 2013(1.04% and 0.42%, respectively). Moreover, the average length of hospital stay in 2014 was lower than that in 2013 (12.46 d vs. 12.90 d), as well as the incidence rate of complications (2.02% vs. 5.03%).

  Conclusion  In addition to ensuring safe healthcare and efficient medical service, comprehensive and whole process blood management could reduce the volume of allogeneic blood transfusion in patients undergoing orthopedic surgeries.