Blood transfusion in hip and knee replacement in Thailand: A call to transition from crossmatch to type-and-screen

Total knee and hip arthroplasties carry a risk of intra- and post-operative blood loss. Effective blood management is therefore crucial for patient safety and the optimal management of hospital resources. In Thailand, where healthcare resources are heavily utilized under the Universal Coverage scheme, transitioning from ritualistic blood ordering to evidence-based practice is essential.

To identify independent risk factors affecting the need for blood transfusion and to evaluate the efficiency of blood ordering practices using the crossmatch-to-transfusion (C:T) ratio in patients undergoing hip and knee arthroplasty.

A retrospective analytical study was conducted on 1554 patients undergoing surgery at a single institution. Demographic, clinical, and surgical data were analyzed. Multivariable logistic regression was used to determine independent predictors of blood transfusion. The C:T ratio was calculated according to the type of procedure to assess resource utilization efficiency.

Of the 1554 patients, 487 (31.3%) required post-operative blood transfusion. Multivariable analysis identified independent risk factors, including age greater than 70 years, bilateral surgery, the use of a redivac drain (OR 1.425, p = 0.006), and a longer operative time (OR 1.006, p = 0.005). Pre-operative anemia (Hct < 30%) was found to be the most significant predictor (OR for the Hct ≥ 30% group = 0.074, p < 0.001). Regarding the efficiency of blood ordering, the overall C:T ratio was 1.5. However, the C:T ratio reached 7.3 in the unicompartmental knee arthroplasty (UKA) group and 15.7 specifically in the unilateral UKA group.

Pre-operative optimization of hematocrit levels is critical in reducing the likelihood of blood transfusion. Furthermore, current blood ordering practices for UKA are highly inefficient. Transitioning from routine crossmatch to a type-and-screen strategy for UKA cases would reduce medical costs and improve blood bank inventory turnover without compromising patient safety. This approach also empowers nurses to facilitate pre-operative clinic optimization regarding patient education and adherence to treatment plans, reduces the time spent on unnecessary blood ordering, and enhances bedside monitoring in high-risk patient groups.