Mortality, Morbidity and Related Outcomes Following Perioperative Blood Transfusion in Patients with Major Orthopaedic Surgery: A Systematic Review

• Published in: Transfusion medicine and hemotherapy Vol. 45; no. 5; pp. 355 - 367
• Main Authors: Müller, Susanne, Oberle, Doris, Drechsel-Bäuerle, Ursula, Pavel, Jutta, Keller-Stanislawski, Brigitte, Funk, Markus B.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger GmbH 01.10.2018
• Subjects: Systematic Review; Non-haemolytic transfusion reactions; Peri-operative period; Haemovigilance; Meta-analyses; Immunomodulation; Systematic review; Restrictive and liberal transfusion regimes; Erythrocyte transfusion
• ISSN: 1660-3796; 1660-3818
• DOI: 10.1159/000481994

Background: Benefits and risks of liberal and restrictive transfusion regimens are under on-going controversial discussion. This systematic review aimed at assessing both regimens in terms of pre-defined outcomes with special focus on patients undergoing major orthopaedic surgery. Methods: We performed a literature search for mortality, morbidity and related outcomes following peri-operative blood transfusion in patients with major orthopaedic surgery in electronic databases. Combined outcome measure estimates were calculated within the scope of meta-analyses including randomised clinical trials comparing restrictive versus liberal blood transfusion regimens (e.g. MH risk ratio, Peto odds ratio). Results: A total of 880 publications were identified 15 of which were finally included (8 randomised clinical trials (RCTs) with 3,693 patients and 6 observational studies with 4,244,112 patients). Regarding RCTs, no significant differences were detected between the transfusion regimes for all primary outcomes (30-day mortality, thromboembolic events, stroke/transitory ischaemic attack, myocardial infarction, wound infection and pneumonia) and a secondary outcome (length of hospital stay), whereas there was a significantly reduced risk of receiving at least one red blood concentrate under a restrictive regimen. Conclusion: The results of this systematic review do not suggest an increased risk associated with either a restrictive or a liberal transfusion regimen in patients undergoing major orthopaedic surgery.