Abstract
Objectives
The main objective of the study was to validate the protocol for performing TKA without admission to the ICU in the postoperative period. The secondary objective was to evaluate the transfusion rate blood flow for the same specific group of patients after surgery.
Methods
After approval of the study by the Institution’s Research Ethics Committee,270 cases of TKA performed between January 2020 and December 2021. All patients undergoing TKA in the period had followed the screening protocol defined by orthopedists, anesthetists and clinicians, after reviewing the literature. The seven criteria used were: age up to 75 years, body mass index up to 35 kg/m2, ASA score classification I or II (American Society of Anesthesiology), non-smoker, no previous history of ischemic disease (coronary or cerebral), creatinine clearance greater than 60mL/min, hemoglobin greater than 12g/dL, osteoarthritis with deformity treatable with a primary prosthesis.
Results
270 patients who underwent TKA between January 2020 and December 2021 were included in the study, following the pre-defined screening protocol. The sample consisted of 182 female and 88 male patients. The average age was 65.5, ranging between 39 and 75 years. Only one patient required ICU surveillance after the surgical procedure, due to hemodynamic instability, giving the screening protocol a positive predictive value of 99.6%. Although there was a significant decrease in serum levels, no patient presented hemodynamic symptoms or clinical indication for blood transfusion.
Conclusion
The proposed screening protocol demonstrated that, following the criteria established, TKA can be performed without the need for ICU reservation, without typing preoperative blood supply and/or reserve of blood products, without compromising patient safety. The rational use of health resources allows the coverage of a greater number of patients, increasing the effectiveness of the system.