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PLASTIC RECONSTRUCTIVE AND REGENERATIVE SURGERY

Original article

Blood Transfusion - 4 2021 (July-August)

Mortality and clinical outcome of Italian patients undergoing orthopaedic surgery: effect of peri-operative blood transfusions

Authors

Elvira Grandone , Mario Mastroianno , Antonio de Laurenzo , Lazzaro di Mauro , Massimo Carella , Franco Gorgoglione , Domenico Cornacchia , Grazia de Angelis , Giovanni L. Tiscia , Angelo Ostuni , Maurizio Margaglione

Key words: peri-operative, blood transfusion, orthopaedics
DOI: 10.2450/2020.0059-20
Publication Date: 2020-10-14

Abstract

Background - Blood transfusion is a relevant issue for elderly and frail patients, as they are often anaemic and have chronic diseases. Transfusion of red blood cells (RBC) can potentially affect morbidity and mortality of elderly patients undergoing major orthopaedic surgery.
Materials and methods - We carried out a retrospective analysis of 2,593 patients undergoing major orthopaedic surgery between 2013 and 2017 in a single research institution in the Region of Apulia. The aims of the study were: 1) to describe the characteristics of transfused patients according to a restrictive or liberal strategy of transfusion and haemoglobin (Hb) triggers and targets; 2) to investigate the effect of RBC transfusion on mortality and complications.
Results - Older, women and patients  with  American Society of Anesthesiologists (ASA) score 3-4 were more often transfused. Those with lower admission Hb level had a higher risk of being transfused. Hb triggers were associated with the patients' age. A restrictive transfusion strategy was significantly more frequent in patients undergoing primary knee replacement and in those with higher estimated blood loss. We did not observe any significant difference of complications in patients transfused with a liberal vs restrictive strategy. Logistic regression correcting for potential confounders revealed that sex (males more than females), duration of stay in hospital, hip fracture and Charlson score >4 were good predictors of complications and/or mortality. Mortality was significantly higher in males and in older patients with ASA score 3-4.
Discussion - In this large cohort of Italian patients undergoing major orthopaedic surgery males were significantly more exposed than women to complications and in-hospital mortality. Furthermore, those undergoing urgent surgery because of hip fracture had a 3-fold higher chance of complications. Charlson score >4 and ASA 3-4 are good predictors of complications and mortality, respectively.

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Authors

Elvira Grandone - Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy; Obstetrics and Gynaecology Department of The First I.M. Sechenov Moscow State Medical University, Moscow, Russia

Mario Mastroianno - Scientific Direction, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy

Antonio de Laurenzo - Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy

Lazzaro di Mauro - Immunohaematology and Transfusion Medicine Service, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy

Massimo Carella - Scientific Direction, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy

Franco Gorgoglione - Orthopaedics Department, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy

Domenico Cornacchia - Orthopaedics Department, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy

Grazia de Angelis - Anaesthesiology/Critical Care Medicine, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy;

Giovanni L. Tiscia - Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Foggia, Italy

Angelo Ostuni - Immunohaematology and Transfusion Medicine Service, University Hospital of Bari, “Aldo Moro” University of Bari, and Regional Coordination Facility of Puglia, Bari, Italy

Maurizio Margaglione - Medical Genetics, University of Foggia, Foggia, Italy

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