[Medical and cost efficiency of autologous blood donation in total hip or knee replacement]

Preoperative autologous blood donation before joint replacement has become standard practice. However, this procedure is discussed controversially regarding medical benefit and cost-effectiveness.

In a retrospective study the data of 994 patients scheduled for hip (THR) or knee arthroplasty (TKR) between 1/2000 and 9/2002 were analysed.

Altogether 612 patients donated autologous blood (61.6 %). 50.2 % of the patients got blood transfusions during surgery or in the course of their hospitalisation. Donors received blood units more often than non-donors (55.2 vs. 41.9 %). On average 1.4 +/- 1.7 blood units were given during or after THR and 0.8 +/- 1.1 units during or after TKR. Clear predispositions for an increased use of blood transfusions were cemented endoprosthesis, old age (> 70 years) as well as exclusive general anaesthesia. Since 57.8 % of the blood units were wasted, the additional expenses (only laboratory and material costs were calculated) for each retransfused autologous blood unit were calculated to be 28.76.

Besides saving homologous blood, autologous blood donation causes mainly an increased probability of giving transfusions and higher costs. Therefore autologous blood donation should be indicated more critically, especially in younger patients and knee replacements.