The Journal of Bone and Joint Surgery (American) 84:1299-1304 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
A Prospective, Randomized Study of Preoperative Autologous Donation for Hip Replacement Surgery
Dinna B. Billote, MD,
Silas N. Glisson, PhD,
David Green, MD, PhD and
Richard L. Wixson, MD
Investigation performed at Northwestern Memorial Hospital of
Northwestern University Medical School, Chicago, Illinois
Dinna B. Billote, MD
Department of Anesthesia, St. Joseph's Hospital, 2900 North Lakeshore
Drive, Chicago, IL 60657. E-mail address: dbillote{at}ameritech.net
Silas N. Glisson, PhD
Department of Anesthesiology, Northwestern Memorial Hospital,
Feinberg Pavilion 5-704, 251 East Huron Street, Chicago, IL 60611.
E-mail address: s-glisson@nwu.edu
David Green, MD, PhD
Department of Hematology/Oncology, Northwestern Memorial Hospital,
675 North St. Clair Street, Galter 14-100, Chicago, IL 60611
Richard L. Wixson, MD
Department of Orthopaedic Surgery, Northwestern Memorial Hospital,
676 North St. Clair Street, Suite 450, Chicago, IL 60611. E-mail
address: rwixson@nwu.edu
In support of their research or preparation of this manuscript, one
or more of the authors received grants or outside funding from Northwestern
Memorial Hospital Intramural Fund. None of the authors received
payments or other benefits or a commitment or agreement to provide
such benefits from a commercial entity. No commercial entity paid
or directed, or agreed to pay or direct, any benefits to any research
fund, foundation, educational institution, or other charitable or
nonprofit organization with which the authors are affiliated or associated.
Background:
Preoperative autologous blood donation is commonly performed to
meet potential perioperative transfusion needs and is a common practice
prior to total hip arthroplasty. Using standardized transfusion
guidelines, we prospectively analyzed the effectiveness of preoperative
autologous donation as a method for decreasing allogeneic transfusion
among patients undergoing unilateral primary total hip replacement who
were eligible to donate autologous blood.
Methods:
Patients who were scheduled for primary total hip replacement surgery
and who had a preoperative baseline hemoglobin level  120
g/L were randomized either to donate two units of blood (autologous
donors) or not to donate any blood (nondonors). The donors and nondonors
were compared with regard to demographic data, blood-loss volumes,
hemoglobin measurements, and transfusion rates. Randomization continued
until data were obtained from at least forty patients per treatment
group.
Results:
Of the ninety-six patients who completed the study, forty-two were
autologous donors and fifty-four were nondonors. There were no significant
differences between the donors and nondonors with regard to age,
male:female ratio, estimated blood volume, baseline physical condition,
or operative blood loss. The hemoglobin values at the time of enrollment
(baseline), at the time of hospital discharge, and six weeks postoperatively were
not significantly different between the two groups, although values
at the time of admission (129 ± 13 g/L versus 138 ±
12 g/L) and in the recovery room (104 ± 12 g/L versus
115 ± 13 g/L) were significantly lower in the autologous
donor group (p < 0.05). No patient in either group required
an allogeneic transfusion. Twenty-nine (69%) of the forty-two donors
received an autologous transfusion. Thirty-four (41%) of eighty-two
autologous units were wasted. At a charge of $379 per autologous unit,
there was an additional cost of $758 for each patient in the donor
group.
Conclusions:
Preoperative autologous donation provided no benefit for nonanemic
patients undergoing primary total hip replacement surgery. Preoperative
autologous donation increased the likelihood of autologous transfusion,
wastage of predonated units, and costs.
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Letters to the Editor:
Read all Letters to the Editor
- The Intangible aspects of Autologous Transfusions
- Chris J. Dangles
- JBJS Online, 14 Aug 2002
[Full text]
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