MAJÖR ARTROPLASTİLERDE KAN TRANSFÜZYONU: SIKLIK, NEDENLER VE TRANSFÜZYONUN İYİLEŞME ÜZERİNDEKİ ETKİSİNİN ARAŞTIRILMASI

BLOOD TRANSFUSION IN MAJOR ARTROPLASTIES: FREQUENCY, CAUSES AND INVESTIGATION OF TRANSFUSION EFFECT ON OUTCOME

Özet

Amaç: Majör artroplastilerde transfüzyon oranlar›, transfüzyon indikatörleri ve transfüzyonun iyileflmeye etkisinin araflt›r›lmas›d›r. Yöntem: Temmuz-Aral›k 2017 döneminde D›flkap› Y›ld›r›m Beyaz›t Sa¤l›k Uygulama Araflt›rma Merkezi’nde diz ve kalça artroplastisi yap›lan olgular›n hasta, anestezi ve ameliyat özellikleri, transfüzyon öncesi-sonras›, hemoglobin-hematokrit-trombosit de¤erleri, p›ht›laflma testleri sonuçlar›, transfüzyon endikasyonlar›, postoperatif istenmeyen olaylar, postoperatif mobilizasyon ve taburculuk süresi verileri prospektif olarak kaydedildi. Çocuklar, gebeler araflt›rmaya dahil edilmedi. Transfüzyon yap›lan ve yap›lmayan hastalar aras›nda fark saptanan de¤iflkenlerden transfüzyon yap›lmas› ile iliflkili en kuvvetli nedenleri ve transfüzyonun mobilizasyon gecikmesi ve hastanede yat›fl süresi uzamas› ile de¤erlendirilen iyileflmeye etkisini saptamak için çok de¤iflkenli regresyon analizleri yap›ld›. Bulgular: Araflt›rma döneminde 418 hasta (330 kad›n, 88 erkek) incelendi. Diz ve kalça artroplastisi yap›lan hasta say›s› s›ras›yla 281 ve 137’di. Perioperatif transfüzyon oran› %28.2 idi (n:95) [preoperatif %4.8 (n:20); intraoperatif %4.5 (n:19); postoperatif %19.9 (n:83)]. Transfüzyon endikasyonlar› s›ras›yla preoperatif dönemde: anemi, kanama; intraoperatif dönemde: kanama miktar›n›n fazla olmas›, hipotansiyon, hemoglobin düflüklü¤ü, laktat yüksekli¤i, yandafl hastal›k varl›¤› ve postoperatif dönemde: hemoglobin düflüklü¤ü, yandafl hastal›k varl›¤›, kanama miktar›n›n fazla olmas›d›r. Perioperatif kan transfüzyonu riskinin preoperatif anemi varl›¤› (OR: 9.34, [%95 GA 0.056-0.204]), traneksamik asit kullan›lmamas› (OR: 3.63, [%95 GA 1.556-8.47]), yandafl hastal›k varl›¤› (OR: 2.76, [%95 GA 1.39-5.46]), turnike kullan›lmamas› (OR: 2.54, [%95 GA 1.121-5.78]), uzun cerrahi süre (OR: 1.017) ve yüksek kanama miktar› (OR: 1.002, [%95 GA 1.001-0.004]) ile artt›¤› saptand›. Tromboembolik olay, iskemik olay, akut böbrek yetmezli¤i ve enfeksiyon görülme s›kl›¤› transfüzyon yap›lanlarda daha yüksekti. Postoperatif 1,2 ve 3.günde mobilizasyon gecikmesi ve uzam›fl hastanede yat›fl için transfüzyon miktar›n›n fazla olmas›n›n (s›ras›yla OR: 1.41 [%95 GA 1.127-1.77] OR: 1,42 [%95 GA 1.093-1.86]; (OR: 1.38 [%95 GA 1.171-1.645]); (OR: 1.32 [%95 GA 1.064-1.63]) ve uzam›fl hastanede yat›fl için transfüzyon yap›lm›fl olmas›n›n (OR: 2.62 [%95 GA 1.028-6.69]) ba¤›ms›z risk faktörü oldu¤u saptand›. Sonuç: Hastanemizde majör artroplastilerde transfüzyon oran› %28.2’dir. Transfüzyon nedenleri anemi, kanama olmas›, kanama miktar›n›n fazla olmas›, hipotansiyon, hemoglobin efli¤i ve yandafl hastal›k varl›¤›d›r. Preoperatif anemi varl›¤›, yandafl hastal›k varl›¤›, traneksamik asit ve turnike kullan›lmamas›, ileri yafl, uzun ameliyat süresi ve kanama miktar›n›n artmas› transfüzyon yap›lmas› için ba¤›ms›z risk faktörleridir. Transfüzyon yap›lmas› ve transfüzyon mik- tar›n›n artmas› iyileflmeyi geciktiren ba¤›ms›z risk faktörleridir.

Abstract

Objective: To investigate the transfusion rates, transfusion indications and the effect of blood transfusions on recovery after major artroplasty. Method: Patients undergoing hip and knee arthroplasty at Diskapi Yildirim Beyazit Training and Research Hospital between July-December 2017 were evaluated with a prospective observational cross sectional study design. Data concerning patient, anesthesia and surgical characteristics, hemoglobin-hematocrit- platelet values before and after transfusion, coagulation test results, transfusion indications, postoperative mobilization time and discharge time were recorded. Pediatric and pregnant patients were excluded. Data were compared between transfused and non-transfused patient groups and multiple regression analysis was performed to explore the factors with the strongest association with blood transfusion and the effect of transfusion on recovery as defined with mobilization delay and prolonged length of stay (PLOS). Results: During the study period 418 patients were evaluated; 330 female and 88 male and 281 of them underwent knee arthroplasty and 137 hip arthroplasty. The perioperative rate of blood transfusion was 28.2%, (n: 95) [4.8% (n:20) preoperative; 4.5% (n:19) intraoperative; 19.9% (n:83) postoperative].The transfusion indications were anemia and bleeding in the preoperative period; the amount of bleeding, hypotension, low hemoglobin value, hyperlactatemia, presence of comorbidities in the intraoperative period and low hemoglobin value, presence of comorbidities and the amount of bleeding in the postoperative period respectively. Multivariate analysis revealed that the risk of receiving blood transfusion increased with preoperative anemia (OR: 9.34, [%95 CI 0.056-0.204]), not using tranexamic acid (OR: 3.63, [%95 CI 1.556-8.47]), presence of comorbidities (OR: 2.76, [%95 CI 1.39-5.46]), not using tourniquet (OR: 2.54, [%95 CI 1.121-5.78]), increased amount of bleeding (OR: 1.002, [%95 CI 1.001-0.004]). The amount of bleeding was an independent risk factor for delayed postoperative mobilization at the 1st, 2nd and 3rd days and Plos (OR: 1.41 [%95 CI 1.127-1.77] OR: 1.42 [%95 CI 1.093-1.86]; (OR: 1.38 [%95 CI 1.171-1.645]); (OR: 1.32 [%95 CI 1.064-1.63] respectively) and being transfused was an independent risk factor for PLOS (OR: 2.62 [ %95 CI 1.028-6.69]). Conclusion: The perioperative transfusion rate in patients undergoing arthroplasty in our hospital is 28.2%. The indications for transfusion are anemia, blood loss, the amount of blood loss, hypotension, hemoglobin trigger and the presence of comorbidities respectively. The presence of preoperative anemia and comorbidities, avoidance of tranexamic acid and tourniquet use, advanced age, increased surgery duration and amount of bleeding are the independent risk factors for transfusion in patient undergoing major arthroplasty. Transfusion itself and the amount of transfusion are independent risk factors for delayed recovery.