RISK STRATIFICATION PROTOCOL FOR PERFORMING TOTAL KNEE ARTHROPLASTY.

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Healthcare Management

Background:

• Intensive care unit (ICU) admission and blood transfusions are common concerns following total knee arthroplasty (TKA).
• Optimizing patient selection and perioperative protocols can potentially reduce the need for intensive care and blood products.

Purpose of the Study:

• To evaluate a screening protocol for performing TKA without postoperative ICU admission.
• To assess the postoperative blood transfusion rate in patients undergoing TKA under the new protocol.

Main Methods:

• A clinical protocol was applied to 270 TKA patients between January 2020 and December 2021.
• Inclusion criteria included age ≤ 75 years, BMI ≤ 35 kg/m², ASA I-II, non-smoker, no history of ischemic disease, creatinine clearance > 60 mL/min, and hemoglobin > 12 g/dL.
• Data collected included ICU conversion rates and blood transfusion requirements.

Main Results:

• Only one out of 270 patients required ICU admission, yielding a positive predictive value of 99.6% for the screening protocol.
• No patients in the study sample required blood transfusions postoperatively.

Conclusions:

• The developed screening protocol is effective for TKA, safely avoiding the need for ICU bed reservation and blood product management.
• This protocol allows for TKA without compromising patient safety, potentially streamlining surgical workflows and resource utilization.