Utility of rotational thromboelastometry in total hip replacement revision surgery (case-control study).

Area of Science:

• Anesthesiology
• Transfusion Medicine
• Orthopedic Surgery

Background:

• Total hip replacement revision surgery is associated with substantial perioperative blood loss.
• Coagulopathy is a common complication, increasing risks and transfusion requirements.

Purpose of the Study:

• To evaluate the impact of point-of-care rotational thrombelastometry (ROTEM) on blood loss and transfusion product consumption during hip replacement revision surgery.
• To determine if ROTEM-guided management reduces perioperative bleeding compared to conventional methods.

Main Methods:

• A case-control study comparing 45 patients managed with ROTEM to 45 historical controls.
• Prospective data collection for the ROTEM group (2017-2018) versus retrospective data for the non-ROTEM group (2015-2016).
• Comparison of perioperative blood loss and consumption of fresh frozen plasma (FFP) and packed red blood cells (PRBCs).

Main Results:

• The ROTEM group showed significantly decreased perioperative blood loss compared to the non-ROTEM group (P < .05).
• Significantly lower consumption of FFP and PRBCs was observed in patients managed with ROTEM.
• ROTEM-guided therapy demonstrated a statistically significant reduction in blood loss and transfusion product usage.

Conclusions:

• Perioperative management guided by ROTEM results effectively reduces blood loss during hip replacement revision surgery.
• ROTEM facilitates targeted therapy for coagulopathy, leading to decreased transfusion requirements, particularly for FFP.
• Point-of-care ROTEM is a valuable tool for optimizing bleeding management in complex orthopedic procedures.