Acta Ortopédica Mexicana

Torres-Gómez A, Mallen-Trejo A
Associated factors due to major bleeding in total hip replacement
Acta Ortop Mex 2015; 29 (5)

Language: Español
References: 17
Page: 245-250
PDF: 174.29 Kb.

[Fulltext - PDF]


Total hip arthroplasty is a common procedure whose typical duration is greater than 90 minutes and is associated with substantial blood loss. It is usually performed in patients › 60 years who have comorbidities. Knowing the factors associated with major bleeding in patients undergoing this procedure will allow us to identify patients who are at risk. Material and methods: We performed a retrospective study, according to a case-control model selecting patients for the primary outcome: major bleeding/not major bleeding. We included 142 patients treated with total hip arthroplasty, divided into 47 cases and 95 matched controls. Results: The variables that showed a higher association to influence the presence of major bleeding was preoperative hemoglobin and hematocrit, BMI, operating time, as well as the use of blood transfusion increased the time of hospital stay. The preoperative hemoglobin value showed that the type of patient more associated with major bleeding had a hemoglobin › 13 g/dl. We observed that 102 patients (71.8%) who underwent a blood transfusion had an increased length of stay (p 0.007). Conclusion: The presence of major bleeding is a frequent event. When knowing the factors associated with major bleeding, the surgical team can anticipate this event and modify it as possible.

Key words: Bleeding, arthroplasty, hip, risk, hemoglobin.


  1. Pola E, Papaleo P, Santoliquido A, Gasparini G, Aulisa L, De Santis E: Clinical factor associated with an increased of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. J Bone Joint Surge Am. 2004; 86-A(1): 57-61.

  2. Billote DB, Glisson SN, Green D, Wixson RL: A prospective, randomized study of preoperative autologous donation for hip replacement surgery. J Bone Joint Surg Am. 2002; 84: 1299-304.

  3. Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC Jr, Dekutoski MB, Bryant S: Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine. 2000; 25: 596-601.

  4. Pierson JL, Hannon TJ, Earles DR: A blood-conservation algorythm to reduce blood transfusions after total hip and knee arthroplasty. J Bone Joint Surge Am. 2004; 86A: 1512-8.

  5. Salido JA, Marin LA, Gómez LA, Zorrilla P, Martínez C: Preoperative hemoglobine levels and the need for transfusion after prosthetic hip and knee surgery. J Bone Joint Surge Am. 2002; 84-A(2): 216-20.

  6. Spahn DR, Casutt M. Eliminating blood transfusions; new aspects and perspectives. Anesthesiology. 2000; 93(1): 242-55.

  7. McSwiney MM, O’Farrel D, Joshi GP, McCarrol SM: Blood transfusion in total hip arthroplasty guidelines to eliminate overtransfusion. Can J Anaesth. 1993; 40(3): 222-6.

  8. Niveles de referencia empleados por el Centro Médico ABC de acuerdo con la base de datos del Laboratorio. ABC Centro Médico México s.n., 2010.

  9. Jensen LS, Grunnet N, Hanberg Sorensen F, Jorgensen J: Cost effectiveness of blood transfusion and white cell reduction in elective colorectal surgery. Transfusion. 1995; 35(9): 719-22.

  10. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tomms RE, Welch RB: An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surge Am. 1999; 81: 2-10.

  11. Dekutoski MB: Blood loss and transfusion management in spinal surgery. Orthopedics. 1999; 22(Suppl. 1): S155-7.

  12. Faris PM, Ritter MA, Abels RI: The effects of recombinant human erythropoietin transfusion requirements in patients having major orthopaedic operation. The American Erythropoietin Study Group. J Bone Joint Surg Am. 1996; 78: 62-72.

  13. Jaffe K: Blood management challenges in orthopedic oncology. Orthopedics. 1992; 22(Suppl 1): S161-63.

  14. Faris PM, Spence RK, Larholt KM, Sampson AR, Frei D: The predictive Power of baseline hemoglobin for transfusion risk in surgery patients. Orthopedics. 1999; 22(Suppl. 1): S135-40.

  15. Sculco TP, Gallina J: Blood management experience: relationship between autologous blood donation and transfusion in orthopedic surgery. Orhopedics. 1999; 22(Suppl. 1): S129-34.

  16. Stowell CP, Chandler H, Jové M, Gullfoyle M, Wacholtz MC: An open label, randomized study to compare the safety and efficacy of preoperative autologous blood donation in total hip joint arthroplasty. Orthopedics. 1999; 22(1 Suppl): S129-34.

  17. Mears DC, Durbhakula SM, Miller B: Developments in blood management: the potential therapeutic role for epoetin alfa in orthopedic trauma. Orthopedics. 1999; 22(Suppl 1): S151-4.