[RBC Transfusion Triggers in Orthopaedic Lower Limb Arthroplasty]

Introduction We implemented a hospital-wide mandatory RBC transfusion trigger checklist based on the haemoglobin level transfusion thresholds recommended by the German federal physicians board. Transfusion triggers, transfusion rates and hospital LOS in orthopaedic lower limb arthroplasty were compared before and after implementation of the transfusion trigger checklist. The goal was to evaluate the effect of this single and easy-to-implement intervention on transfusion rates in orthopaedic lower limb arthroplasty. Methods 893 patients for elective THR or TKR were enrolled in two separate 6-month intervals: 481 patients before and 412 patients after implementation of the RBC transfusion trigger checklist. In addition to demographic data, we collected haemoglobin values pre-operatively, at POD 5 and before any RBC transfusion, in order to calculate and compare the total perioperative blood loss and transfusion triggers in the two groups. Transfusion rates and hospital LOS were recorded and evaluated. Results Transfusion rates changed from 12.3% (THR) and 12.3% (TKR) to 4.7% (THR) and 3.2% (TKR) after implementation of the transfusion trigger checklist. The average haemoglobin transfusion threshold changed from 8.17 to 7.13 g/dl. Hospital LOS changed from 10.20 (THR) and 10.59 (TKR) days to 9.48 (THR) and 9.81 (TKR) days. Conclusion A mandatory RBC transfusion trigger checklist is a very effective tool to optimise transfusion rates and to control haemoglobin-based transfusion thresholds in orthopaedic lower limb arthroplasty. Negative effects, such as prolonged hospital LOS, were not observed.