DOS 2016

156

· DOS Abstracts

The total blood loss after transfemoral

amputations is more than twice the intraoperative

loss.

Christian Wied, Peter Toft Tengberg, Morten Tange Kristensen, Gitte Holm,

Thomas Kallemose, Anders Troelsen, Nicolai Bang Foss

Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre;

Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Department of

Physiotherapy, Copenhagen University Hospital Hvidovre; Department of Orthopaedic

Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopaedic

Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopaedic Surgery,

Copenhagen University Hospital Hvidovre; Department of Anesthesiology and Intensive

Care, Copenhagen University Hospital Hvidovre

Background:

Underestimation of the actual blood loss in patients undergoing dysvascu-

lar Transfemoral Amputation (TFA) can impact negatively on outcome, in these often frail

patients with very limited physiological reserves.

Purpose / Aim of Study:

To estimate the Total Blood Loss (TBL) after TFA. Secondly, to

evaluate the impact of blood loss and transfusions on the 30-days mortality and medical

complications.

Materials and Methods:

A single-center retrospective cohort study conducted from

2013 to 2015. The TBL was calculated on the fourth postoperative day, and based on

the development in hemoglobin levels, transfusions, and the estimated blood volume.

Hemoglobin was measured daily until the fifth post- operative day, and transfusions

were given at a red blood cell (RBC) level below 9.7 g/dl.

Findings / Results:

In all 81 TFA patients were studied. The TBL was calculated to a

median of 964ml (IQR: 407-1521). The intraoperative blood loss (OBL) was measured

to 400ml (IQR: 250-550), and the difference between TBL and OBL was 688ml (IQR:

180-1156). The patients received RBC transfusions with a median amount of 2 units

per patient. Adjusted multivariable analysis showed that the TBL on average was 489

(95%CI, 38 – 940, p=0.034) ml larger in patients suffering from kidney disease prior to

surgery. The TBL was not independently associated with increased 30-days mortality or

medical complications, nor was transfusions above 2 units.

Conclusions:

The TBL after TFA’s is significantly greater than the estimated OBL, and

significantly increased if kidney disease is present prior to surgery. A high anemia vigi-

lance seems recommendable in the perioperative period and especially after TFA surgery.

No conflicts of interest reported

107.