The value of preoperative haemoglobin level as an indicator of blood loss in total hip arthroplasty: results of a multicentre pilot and prospective study
NR Chenthil Kumar1, Mohammad Maqsood1, G Kumar Reddy2, Elmoez M H Obeid3, Anele O Ebizie3
1Departments of Orthopaedics, County Hospital, Lincoln, Lincolnshire; United Kingdom
2Departments of Orthopaedics, New Cross Hospital, Wolverhampton,West Midlands; United Kingdom
3Departments of Orthopaedics, Tameside General Hospital, Ashton Under Lyne, Lancashire; United Kingdom
Keywords: Blood loss, surgical; blood transfusion; hemoglobins; hemorrhage; hip joint/surgery; hip prosthesis; intraoperative period.
Objectives: Primary total hip arthroplasty (THA) is an elective orthopaedic procedure that is associated with significant blood loss. This multicentre pilot and prospective study was carried out to determine the amount of blood loss in THA using blood haemoglobin (Hb) as an indicator to help predict blood loss for a particular patient during the preoperative assessment.
Patients and methods: The study included 723 patients (416 females, 307 males; mean age 68 years; range 69 to 79 years) who underwent primary single-sided THA at three different hospitals. All the operations were performed under normotensive general anaesthesia. Preoperatively, blood Hb value was at least 12 g/dl, without a history of any preoperative transfusions. Haemoglobin was measured at 24 and 48 hours postoperatively. The mean difference in Hb measured before surgery and at postoperative 48 hours was calculated, which was defined as the amount of blood loss.
Results: Pre- and postoperative (48 hours) blood Hb levels ranged from 12.0 g/dl to 15.3 g/dl (mean 12.8 g/dl) and from 7.8 g/dl to 11.3 g/dl (mean 8.6 g/dl), respectively. The mean difference between the pre- and postoperative blood Hb levels was 4.2 g/dl.
Conclusion: An estimated amount of blood loss (4.2 g/dl) can be used as a simple and useful guide in the preoperative assessment of patients undergoing THA. It may help the surgeon anticipate the amount of blood loss, without requiring complicated calculations and costly procedures.