Abstract:
Background: Perioperative blood loss in South
African (SA) primary hip arthroplasty patients has
not been described. This information could improve
patient management during the perioperative period in
this setting. Our study objectives were to 1) determine
perioperative blood loss in SA primary hip arthroplasty
patients, and 2) determine which characteristics are
associated with major perioperative blood loss in SA
primary hip arthroplasty patients.
Methods: This was a retrospective cohort study of
174 patients who underwent primary hip arthroplasty
over a 22-month period at the Inkosi Albert Luthuli
Hospital, SA. All patients were part of a pre-existing
registry. Data for each patient included: Age, gender,
anthropometric measurements, comorbidity, orthopaedic
variables, laboratory test results, American Society of
Anesthesiologists Score, general anaesthesia, duration
of surgery, preoperative tranexamic acid, postoperative
thromboprophylaxis, and perioperative blood transfusion.
Estimated perioperative blood loss (in mL) was calculated
using the Gross Equation. Minimum, maximum, mean,
and median perioperative blood loss were calculated.
Major perioperative blood loss was defined as an estimated
perioperative blood loss which was >75th percentile
obtained for the study sample. Data were analyzed using
appropriate methods.
Results: Perioperative blood loss ranged from 10.3
mL to 3041.8 mL. Mean perioperative blood loss was
1103.1 ± 556.2 mL. Median perioperative blood loss was
1008.8 mL, with an interquartile range of 706.2–1357.0
mL. Independent statistical associations were observed
between major perioperative blood loss and the following
characteristics: chronic obstructive pulmonary disease
(OR: 3.01, 95% CI: 1.01–8.95; p=0.048), preoperative
tranexamic acid (OR: 0.28, 95% CI: 0.13–0.63; p=0.002),
and perioperative blood transfusion (OR: 10.18, 95% CI:
3.53–29.34; p<0.001).
Conclusion: The levels of perioperative blood loss
observed in our sample of SA primary hip arthroplasty
patients are consistent with the range of estimated
blood loss reported in the published literature for hip
arthroplasty populations in other countries. SA primary
hip arthroplasty patients who suffer major perioperative
blood loss are more likely to have COPD or require
perioperative blood transfusion. Preoperative tranexamic
acid was protective against major perioperative blood loss.
