Today's News

Thursday, March 19, 1998

Acute normovolemic hemodilution more cost-effective, less wasteful than preoperative autologous blood

Acute normaovolemic hemodilution (ANH) should be used as an alternative to preoperative autologous blood (PAD) for elective total hip replacement surgery since it is more economical, according to a study presented Thursday in poster exhibit A 112.

"Besides being less costly, ANH also wastes less autologous blood," said co-author Kurt D. Merkel, MD, research associate at Washington University School of Medicine and on staff at Premier Care Orthopaedics, St. Louis, Mo.

Thirty-three patients undergoing primary total hip replacement were randomly divided into two autologous blood procurement groups: PAD patients were scheduled to donate two units of autologous blood in the month prior to surgery and the rest of the patients were scheduled to undergo ANH on the day of surgery.

An analysis of hospital costs for the blood found that PAD was $157.56 per unit; ANH returned in the operating room was $15.87 per unit; ANH stored postoperatively was $55.56 per unit; allogenic was $113.36 per unit. For the PAD group, transfusion costs were significantly higher, and 14 of 36 units (39 percent) of autologous blood were wasted compared to 7 to 30 units (23 percent) in the ANH group.

All patients received a standardized general anesthetic and had autologous blood returned to maintain a hematocrit (hct) equal or more than 24 percent. Postoperatively, blood obtained by ANH was stored if not tranfused prior to discharge from the post-anesthestic care unit.

The treatment groups were comparable with respect to demographic data, EBL, anesthesia times and duration of surgery and hospitalization. At admission, hct was significantly lower in the PAD group, but perioperative and discharge hct values were similar.

Other co-authors of the study from the Washington University School of Medicine, St. Louis, are: Kalvin L. White, DO, assistant professor of anesthesiology; Terri G. Monk, MD, associate professor of anesthesiology; and Lawrence T. Goodnough, MD, department of hematology.

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