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Is it necessary to perform preoperative cross-matching tests on all patients undergoing primary total hip
A Santamaría López1, B de la Hera1, F Nehmé Abouzeid1
1Unidad de Artroplastia, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Getafe, Madrid, España.
Introduction:
Currently, most hospitals systematically request preoperative crossmatching tests for patients undergoing arthroplasty. The aim of this study is to assess whether routine preoperative crossmatch testing (CMT) is necessary for all patients undergoing primary total hip arthroplasty (THA). To this end, we evaluated the transfusion rate, associated clinical risk factors, and the economic impact of routine crossmatch testing.
Material And Methods:
A retrospective study including patients undergoing primary THA for coxarthrosis from 2021 to 2023. Patients with fractures and their complications, as well as prosthetic revisions, were excluded. Epidemiological, clinical, and analytical variables, as well as the cost of routinely performing preoperative CMT were evaluated.
Results:
A total of 273 patients were included (152 males), with a mean age of 66.9 years [27-89]. Tranexamic acid was administered to 207 patients (75.8%), and surgical drains were used in 133 cases (48.7%). The decision to use tranexamic acid and drains was made by the attending anesthesiologist and surgeon, respectively. The mean length of hospital stay was 2.5 days [1.2-3.7]. All surgeries were performed using a posterolateral approach, and all prostheses implanted were uncemented Polar R3® (Smith & Nephew) components. The mean preoperative hemoglobin level was 14.3g/dL [10-19.7], and the postoperative level was 11.1g/dL [7.2-14.7]. Blood transfusion was required in 20 patients (7.3%). No urgent or intraoperative transfusions were recorded; all were prescribed postoperatively at the discretion of the attending surgeon. Female sex, the use of surgical drains, and preoperative hemoglobin <13g/dL were identified as statistically significant risk factors for transfusion (p<0.05). The estimated cost of routine PPCC was €21,840.
Conclusions:
The blood transfusion rate following primary THA was less than 10% (7.3%). It seems reasonable to stop routinely performing CMT for every patient undergoing primary THA and to individualize the indication for transfusion based on each specific case.
