Reducing unnecessary crossmatching for hip fracture patients by accounting for preoperative hemoglobin concentration

doi:10.5312/wjo.v12.i5.292

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Study

World J Orthop. May 18, 2021; 12(5): 292-300
Published online May 18, 2021. doi: 10.5312/wjo.v12.i5.292

Reducing unnecessary crossmatching for hip fracture patients by accounting for preoperative hemoglobin concentration

Raj M Amin, Varun Puvanesarajah, Yash P Chaudhry, Matthew J Best, Sandesh S Rao, Steven M Frank, Erik A Hasenboehler

Raj M Amin, Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA 94305, United States

Varun Puvanesarajah, Sandesh S Rao, Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States

Yash P Chaudhry, Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19122, United States

Matthew J Best, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MD 02114, United States

Steven M Frank, Department of Anesthesiology, Critical Care Medicine, Baltimore, MD 21205, United States

Erik A Hasenboehler, Department of Orthopaedics, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States

Author contributions: Amin RM, Puvanesarajah V, Best MJ, and Hasenboehler EA designed the research study; Amin RM, Chaudhry YP, and Rao SS analyzed the data; Amin RM, Chaudhry YP, Puvanesarajah V, Frank SM, and Hasenboehler EA wrote and edited the manuscript; All authors have read and approve the final manuscript.

Institutional review board statement: Institutional review board approval was obtained for this study (IRB CR00016216).

Conflict-of-interest statement: Hasenboehler EA is a paid consultant for DePuy Synthes Trauma. He receives grant support as well as a grant for a research fellow from DePuy Synthes Trauma. He is also a paid lecturer and faculty for AO North America Trauma and has stock ownership in Summit Med Ventures. Other authors have no conflict-of-interest to disclose.

Data sharing statement: No additional data are available.

Corresponding author: Erik A Hasenboehler, MD, Assistant Professor, Department of Orthopaedics, Johns Hopkins School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21205, United States. ehasenb1@jhmi.edu

Received: January 16, 2021
Peer-review started: January 16, 2021
First decision: January 24, 2021
Revised: February 18, 2021
Accepted: April 9, 2021
Article in press: April 9, 2021
Published online: May 18, 2021
Processing time: 115 Days and 19 Hours

ARTICLE HIGHLIGHTS

Research background

Blood product utilization is becoming increasingly scrutinized in orthopaedic surgery as restrictive transfusion triggers and conservative blood management strategies have become more common.

Research motivation

As transfusion frequency decreases through implementation of restrictive blood management practices, a rethinking of preoperative blood product allocation is required. Rather than using standardized maximum surgical blood order schedules (MSBOS), we wanted to investigate the ideal type and cross ratios for hip fracture patients while accounting for preoperative hemoglobin values.

Research objectives

The aims of this study were to characterize and compare the ideal 2:1 crossmatch to transfusion ratio in hip fracture patients before and after the implementation of a restrictive blood management policy at our institution.

Research methods

A retrospective review was conducted of all operatively treated hip fractures at our institution from January 2013 through May 2017. Cases were split up based on whether they occurred before or after implementation of a patient blood management (PBM) program (January 2015). Receiver operating curve analyses were used to determine the preoperative hemoglobin levels predicting 50% transfusion events in the pre- and post-PBM cohorts.

Research results

Implementation of the PBM resulted in a significant decrease in transfusion requirements from the pre- to post-PBM cohorts (51% vs 33%, P < 0.0001). Additionally, the post-PBM cohort was much less likely to receive multiple transfusions. Compared to the pre-PBM cohort, the post-PBM cohort had a much lower preoperative hemoglobin value that predicted a 50% transfusion probability.

Research conclusions

In order to more appropriately allocate blood product resources, hip fracture MSBOS should be updated to reflect current restrictive transfusion strategies and should consider preoperative patient hemoglobin values.

Research perspectives

Further study at other institutions is warranted to validate the generalizability of our findings. To help conserve resources, additional MSBOS studies are warranted in other orthopaedic trauma surgery procedures as well.