Minimizing Blood Transfusion in Total Hip and Knee Arthroplasty Through a Multimodal Approach
Section snippets
Materials and Methods
The institutional registry of prospectively collected data on 1010 consecutive patients undergoing primary THA (522) or TKA (488) was reviewed after the initiation (May 2012) of the multimodal perioperative blood management algorithm outlined below. Study approval was granted from the institutional review board. The inclusion criteria were primary scheduled THA or TKA. Cases involving revision total joint arthroplasty or fracture were excluded. No patients were excluded for underlying medical
Statistical Methods
Continuous data are expressed as the mean and SD. Differences between groups with regard to age, body mass index (BMI), Hb measures, and American Society of Anesthesiologists (ASA) class were analyzed with use of t test. Categorical data were analyzed with the Fisher exact test.
Results
There was a significant reduction in the overall transfusion rate (1.4% vs 17.9%, P < .0001) for all patients undergoing primary joint arthroplasty after introduction of our protocol, when compared with the historic cohort. There were no significant clinical differences in age, gender, BMI, or ASA class when comparing the study group with the historic cohort (Table 1). There was a nonsignificant decrease in the incidence of observed postoperative stroke (0.13% vs 0.24%, P = .67) and DVT/PE (0.4% vs
Discussion
Implementation of a multimodal, multidisciplinary blood management protocol for all patients undergoing primary scheduled hip or knee arthroplasty resulted in a significant reduction in allogeneic blood transfusions compared with patients undergoing similar procedures just prior to its implementation. This significant reduction in transfusion rates occurred at a tertiary care teaching hospital, in all patients undergoing scheduled arthroplasty, across multiple surgeons of variable subspecialty,
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Cited by (79)
Risk of blood transfusion following total hip arthroplasty: A national database study from 367,894 patients
2023, Journal of OrthopaedicsRoutine Type and Screens Are Unnecessary in Primary Total Joint Arthroplasty: Follow-up After a Change in Practice
2023, Arthroplasty TodayCitation Excerpt :These reduced rates are likely secondary to improved preoperative treatment of anemia and appropriate use of evidence-based transfusion thresholds. Furthermore, administration of tranexamic acid (TXA) has enhanced perioperative hemostasis [5–9]. Institutions have begun updating protocols for use of blood products and related testing to minimize unnecessary costs without sacrificing patient safety.
Who Is Still Receiving Blood Transfusions After Primary and Revision Total Joint Arthroplasty?
2022, Journal of ArthroplastyHome Discharge Has Increased After Total Hip Arthroplasty, However Rates Vary Between Large Databases
2021, Journal of ArthroplastyMore Patients Are Being Discharged Home After Total Knee Arthroplasty, However Rates Vary Between Large Databases
2021, Journal of ArthroplastyCitation Excerpt :Improvements in hospital LOS, percentage of patients discharging home, and reduction in perioperative complications requiring readmission or reoperation are likely a result of the extensive preoperative efforts to optimize patients prior to these elective procedures and advancements in perioperative care, such as rapid recovery protocols. These have been demonstrated to reduce LOS and decrease overall costs of care [14–25]. By year 2016, ACS NSQIP participating hospitals discharged 81.7% of patients home compared to 74.7% of those with Humana plans.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements, refer to http://dx.doi.org/10.1016/j.arth.2015.08.025.