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Predictors of blood loss and haematocrit after periacetabular osteotomy
Cara Beth Lee1, Leslie A Kalish, Michael B Millis
11 Center for Hip Preservation, Department of Orthopaedics, Virginia Mason Medical Center, Seattle, Washington - USA.
Background:
Acetabular dysplasia is a common cause of hip pain that can lead to osteoarthritis. Periacetabular osteotomy (PAO) is an effective procedure to treat symptomatic dysplasia in properly selected patients.
Purpose:
This study aims to determine patient or perioperative variables that are predictive of blood loss (EBL) and postoperative haematocrit (HCT) with PAO.
Patients And Methods:
Between March 2009 and October 2011, 169 PAOs in 141 patients were performed. Associations with EBL (log-transformed) and lowest postoperative haematocrit (post-HCT, <26 vs. ≥26) were assessed by regression analysis, adjusting for surgeon and for within-patient correlations.
Results:
Geometric mean EBL was 925 mL (range 200-3900 mL; 95% CI: 851.3, 1005.1). There was 11.1% greater blood loss per hour of surgery (p = 0.02). Preoperative HCT averaged (±SD) 36.1 (±3.3). In 119 cases (71%), the post-HCT was <26. Lower preoperative HCT correlated with post-HCT <26 (p<0.001); the median ratio of the lowest postoperative HCT to the preoperative HCT was 0.687 (5th, 95th percentiles: 0.538, 0.781). Age, body mass index (BMI), arthrotomy, and anaesthesia-type showed no association with EBL or post-HCT.
Conclusions:
Longer duration of surgery correlated with increased blood loss during PAO. Current guidelines recommend considering transfusion at haemoglobin ≤8 g/dL for postoperative patients. The median nadir post-HCT was 31% lower than the preoperative value, a ratio that may help determine the need for preoperative blood donation. This information facilitates future investigation of blood management with PAO.
