Use of the blood transfusion service in total knee replacement arthroplasty. The cost implications

In view of the rising costs of blood transfusion and reports of inappropriate transfusions an audit of the local practice was organised. The aim was to investigate whether blood transfusion in primary unilateral Total Knee replacement Arthroplasty (TKA) operations was being used inappropriately locally, the resultant cost implications and suggest ways of reducing these. A 1-year retrospective survey of blood transfusion practice was conducted for all consecutive elective, primary, unilateral TKA operations at a District-General Hospital. 169 operations were performed and 58 (34%) patients were transfused. A retrospective Haemoglobin concentration (Hb) analysis was performed for all the transfused patients to identify the number of transfusions that satisfied the suggested transfusion criteria of a threshold Hb of 8 g/dl and when indicated, a minimum transfusion of 2 units. Complete transfusion data was available on 49/58 (84%) patients transfused. When applying the above criteria to this sample, the potential annual saving for the department was estimated at approximately £8000; only 9 of these patients were deemed to be appropriately transfused.