Gülyüz ÖZTÜRK, SELÇUK BÖLÜKBAŞI, Tuğba ÜNSAL, MURAT SONGÜR

Ortopedik cerrahide allojeneik kan transfüzyon politikası

Amaç: Ortopedik cerrahide transfüzyon uygulamalarını değerlendirmek ve merkezimizde ulaşılan başarılı sonuçlar ışığında, ülke çapında uygulanacak transfüzyon politikalarnın gelişimine katkı sağlamak. Çalışma planı: Ocak 1997-Aralık 1999 (1. grup) ve Ocak 2000- Aralık 2002 (2. grup) tarihleri arasında ortopedik cerrahide elektif veya acil olarak ameliyat edilen olgularda istemde bulunulan ve kullanılan kan kayıtları incelendi. Otolog transfüzyon uygulanan hastalar çalışmaya alınmadı. Birinci grup 990 (ort. yafl 50.4), ikinci grup 821 kadın hastadan (ort. yafl 53.3) oluşmaktaydı. Gruplarda maksimum cerrahi kan isteme oranları (MCKİ), transfüzyonda eritrosit süspansiyonu tercihi değerlendirildi. Tüm hastalarda ameliyat sırasındaki hemoglobin düzeyi 10 gr/dl olarak hedeflendi. Ocak 2000 tarihinde uygulamaya konan yeni transfüzyon ilkelerinde, ameliyat sırasında tahmini kan kaybının doğru olarak değerlendirilmesini ve israfın en aza indirilmesini sağlamak; cerrahi işlem sırasında "standart olarak bir ünite kan transfüzyonu yapılmasını" azaltmak; ortaya çıkacak hacim açığını kristalloid ve kolloid süspansiyonlarla kapatarak transfüzyonun mümkünse hiç yapılmamasnı sağlamak; tam kan yerine kan komponenti olarak eritrosit süspansiyonunun tercih edilmesi hedeflenmiflti. Bu ilkeler doğrultusunda, iki dönemdeki kan transfüzyonu uygulamaları kararlaştırıldı. Sonuçlar: Her iki grupta da MCKİ oranları 2'nin altında olmakla birlikte, ikinci grupta daha düşük bulundu. istenen kan oranı nın medyan değeri birinci grupta 2, ikinci grupta 3 ünite; transfüze edilen kan oranının medyan değeri ise sırasıyla 1 ve 2 ünite bulundu. Bu sonuçlar arasındaki fark istatistiksel olarak da anlamlıydı (p

Anahtar Kelimeler:

Ameliyat sonrası komplikasyonlar, Geriyedönük çalışma, Kan nakli, Ortopedik işlemler, Sonuç değerlendirilmesi (Sağlık bakımı), Kan kaybı, cerrahi, Tıbbi kayıtlar

Allogeneic blood transfusion policy in orthopedic surgery

Objectives: This retrospective study was performed to evaluate transfusions in orthopedic surgery and, in the light of our successful practice, to contribute to the development of appropriate transfusion policies in Turkey. Methods: In this study 1811 female patients who underwent orthopedic elective or emergency surgery from January 1997 to December 1999 (group 1) and from January 2000 to December 2002 (group 2) were retrospectively evaluated with respect to ordered and transfused blood units. Autologous blood transfusions were not included. Group 1 consisted of 990 patients (mean age 50.4 years); group 2 consisted of 821 patients (mean age 53.3 years). Maximum surgical blood order schedule (MSBOS) ratios and preference for red blood cell transfusions were determined. Perioperative target hemoglobin level was 10 gr /dL in both groups. In group 2, allogeneic blood transfusions were performed according to the principles established in January 2000, which aimed (i) to more precisely estimate blood loss during s urgical procedures and to prevent inappropriate use of blood products; (ii) to reduce the frequency of "standard one unit transfusion" through administration of crystalloids and colloids to the extent of complete elimination of transfusions; and (iii) to use blood components (erythrocyte suspensions) instead of whole blood. Results: In both groups, the MSBOS ratios were below 2, being 1.83 in group 1, and 1.59 in group 2. The medians of requested and transfused blood units were 2 and 1 in group 1, and 3 and 2 in group 2, respectively, resulting in statistically significant differences (p<0.05). The -standard one unit transfusion- rate was 28.7% in group 1, and 18.9% in group 2. Preferences for red blood cell transfusions showed statistically significant increases over the consecutive years. The use of erythrocyte suspensions was found as 29.2% in group 1, and 95% in group 2. Conclusion: Our data demonstrated that the transfusion policy established for orthopedic surgical procedures at our center resulted in successful applications thanks to a good cooperation between relevant departments and achieved the level of international standards.

Keywords:

Postoperative Complications, Retrospective Studies, Blood Transfusion, Orthopedic Procedures, Outcome Assessment (Health Care), Blood Loss, Surgical, Medical Records,

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