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With the Tranexamic acid, is cost-effective the Routine Preoperative Type And Screen In Total Knee Arthroplasty?
Author(s):
Nuñez J. (Spain)
,
Nuñez J. (Spain)
Affiliations:
Casaccia M.
,
Casaccia M.
Affiliations:
Pons A.
,
Pons A.
Affiliations:
Minguell J.
,
Minguell J.
Affiliations:
Joshi N.
,
Joshi N.
Affiliations:
Castellet E.
Castellet E.
Affiliations:
ESSKA Academy. Nuñez J. 05/09/18; 209570; P09-1390
Dr. Jorge Nuñez
Dr. Jorge Nuñez
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Abstract
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Objectives: In the last decade due to increasing interest in perioperative blood-conserving strategies such as the use of tranexamic acid (TXA) the blood transfusion rate for TKA has decreased. The need for routine preoperative type and screen (TS) has been questioned.

The main objective of our study is to determine the current transfusion rate in the primary TKA depending on the use of TXA and ischemia. As secondary objectives we value the risk factors in patients who needed blood transfusion and the cost analysis of routine preoperative TS.

Methods: Historical cohort study of all patients operated from primary TKA in a third-level institution in 2015. Inclusion criteria: Patients who underwent surgery because of degenerative gonarthrosis, age between 55-88 years old and operated by knee surgeon specialists.

We collected and analyzed demographic and clinical variables. Patients are also classified in 4 groups based on the use of ischemia during the entire surgery or only for the moment of cementing and depending on the use or not of TXA. Group 1: Tourniquet during surgery without TXA. Group 2: Tourniquet during surgery with TXA. Group 3: Tourniquet only to cement without TXA. Group 4: Tourniquet only to cement with TXA.

Our hospital's protocol for transfusions was followed. Patients were transfunded if there was a Hb <8.0 gr/dl, except in high risk patients or symptomatic anemia.

Results: 248 patients met the inclusion criteria (167 women). Average age 72.17 years. The mean preoperative Hb level was 13.88 gr/dl. The mean postoperative Hb level was 10.81 gr/dl. Only 26 patients needed transfusion (11.15%). Moreover, the intraoperative transfusion was 2.14% (5 patients).

In groups: Group 1 (n = 76) had a postoperative transfusion rate of 11.84% and an intraoperative transfusion rate of 1.31%. Group 2 (n = 52) had a postoperative transfusion rate 1.92% and had no intraoperative transfusion. Group 3 (n = 60) had a postoperative transfusion rate of 21.66% and an intraoperative transfusion rate of 6.66%. Group 4 (n = 43) had a postoperative transfusion rate of 6.97% and had no intraoperative transfusion.

Taking oral contraceptives (28.57% vs. 10.13%;OR = 3.54) and having a low preoperative Hb level = 12.0 g / dl (41.8% vs. 10.2 %; OR = 5.96) were associated with a higher risk of transfusion. Other factors such as age, sex, BMI, ASA and antiaggregants were not significant risk factors. The cost of the routine preoperative TS was 160 euros per patient, if the blood reserve had been eliminated, it would have been produced a total health saving of 39,680 euros.

Conclusions: We believe that patient who received TXA do not need preoperative TS. Moreover, with a low postoperative and intraoperative blood transfusion rate, we believe that preoperative TS may not need to be requested for all patients undergoing a primary TKA which would result in health savings. Preoperative TS should be considered only in patients with high risk as those who take anticoagulants and with a preoperative Hb < or = 12.0 gr/dl.

Keywords:
tranexamic acid, routine preoperative type and screen, total knee arthroplasty
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