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Master Thesis

Pertinence des examens immuno-hématologiques pré-opératoires systématiques en chirurgie orthopédique programmée, arthroplastique et du rachis, au CHU de Rennes

Abstract : Background: Thanks to advances in surgery and anesthesia, the rate of blood transfusion in orthopedic surgery has been falling for several decades. We aimed to assess the current relevance of the preoperative immunohematological blood tests systematically requested at the Rennes University Hospital before an arthroplastic or spine surgery Methods : After CERAR approval, patients who underwent elective arthroplastic or spine orthopedic surgery in 2019 were retrospectively included. The primary endpoint was the transfusion rate during the hospital stay. Secondary outcomes were the rate of urgent and unpredictable transfusion and the rate of redundant blood tests. Results : Over the period, 843 patients aged of 66 +/- 14 years old were included. Before surgery, 16% of them were anemic. 10% of the patients received blood transfusion during their hospital stay. In multivariate analysis, age (OR 1.025 [1.003; 1.048] p 0.023) and preoperative hemoglobinemia (OR 0.41 [0.34; 0.51] p <0.0001) were significantly associated with transfusion. Blood transfusion rate was low (<1%) for outpatient total hip arthroplasty, unicompartmental knee arthroplasty, total shoulder arthroplasty (and revision), one-level herniated disc surgery with posterior approach, one or two level lumbar interbody posterior spine fusion, anterior cervical spine surgery, coccygectomy and anterior or lateral lumbar spine interbody fusion. Urgent and unpredictable blood transfusion rate (defined by a transfusion given on day of surgery or later with documented urgency criteria, for the patients who were not anemic before surgery) was low (<1%) for all the hip, knee and shoulder primary arthroplasties. Finally, 40% of patients had at least one unjustified redundant immunohematologic test. Conclusion : Our results show that it is possible to no longer perform systematic immuno-hematological tests for some orthopedic surgical procedures once considered to be at high risk of bleeding but now at low risk. Redundant exams are common and should be avoided.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03245241
Contributor : Santé Rennes 1 Connect in order to contact the contributor
Submitted on : Tuesday, June 1, 2021 - 4:21:40 PM
Last modification on : Saturday, November 27, 2021 - 3:48:06 AM

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Guillaume Allo. Pertinence des examens immuno-hématologiques pré-opératoires systématiques en chirurgie orthopédique programmée, arthroplastique et du rachis, au CHU de Rennes. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03245241⟩

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