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Perioperative protocol to reduce blood transfusions in ankylosing spondylitis patients undergoing total hip arthroplasty


 Introduction: Although tranexamic acid (TXA) can reduce bleeding during total hip arthroplasty (THA), the amount of perioperative bleeding is greater in patients with ankylosing spondylitis (AS); So blood management is more challenging. Patient Blood Management (PBM) program can improve AS patients care and reduce health costs in THA. The purpose of this study is to assess the effects of PMB program on allogeneic transfusion rate, length of hospital stay(LOS), hospitalization expenses and adverse events.
Methods : We conducted a retrospective observational study of patients with AS who underwent THA. All patients were treated with tranexamic acid before and after operation. Our PBM program included preoperative evaluation, preoperative acute normovolemic hemodilution and intraoperative recovery autotransfusion. We compared results between the group of patients before and the one after the PBM program implementation.
Result: We included 68 as patients who underwent total hip arthroplasty before PBM program from January 2013 to December 2015 (group A) and 84 as patients who underwent total hip arthroplasty after PBM program from January 2016 to December 2019 (group B). In the comparison of intraoperative blood transfusion volume, intraoperative blood transfusion rate and total blood transfusion rate between the two groups, the group B was significantly lower than the group A (P ≤ 0.05); The length of stay and hospitalization expenses of the group B were lower than the group A (P ≤ 0.05). No adverse events were recorded.
Conclunsions: Our PMB program can reduce allogeneic blood transfusion, hospital stay and hospitalization expenses, without risking patients to higher number of com- plications in AS patients undergoing THA.