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Algorithm of Trevisan et al for Transfusion Risk After Total Hip Arthroplasty

Description

Trevisan et al evaluated the need for blood transfusion for patients undergoing total hip arthroplasty. The pattern of hemoglobin concentrations before and after surgery can help to triage patients based on transfusion risk. The authors are from the University of Milano-Bicocca, Hospital ASST Bergamo Est, Universita degli Studi di Milano and ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO in Milan.


Patient selection: total hip arthroplasty

 

Outcome: low or high risk for transfusion

 

Testing schedule for hemoglobin:

(1) prior to surgery

(2) on day 1 after surgery

(3) on day 2 after surgery if anemic prior to surgery

 

Criteria for low risk group if goal is highest Youden score and efficacy (Table 3, Group B)

 

Preoperative

Day 1

Day 2

> 13 g/dL

> 9.5 g/dL

NA

<= 13 g/dL

>= 10 g/dL

> 10 g/dL

 

Criteria for low risk group if goal is 100% sensitivity and highest specificity (Table 4, Group B)

 

Preoperative

Day 1

Day 2

> 13 g/dL

> 11.5 g/dL

NA

<= 13 g/dL

>= 10 g/dL

> 11 g/dL

 

The different strategies resulting in 100% sensitivity (and therefore 100% NPV) as shown in Table 4 result in the high risk groups being large (from 70 to 93%).


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