A Blood-Conservation Algorithm to Reduce Blood Transfusions After Total Hip and Knee Arthroplasty

Pierson, Jeffery L.; Hannon, Timothy; Earles, D. R.

doi:10.2106/00004623-200407000-00022

Cited by 112 publications

(84 citation statements)

References 39 publications

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“…Allogenic blood transfusion was performed if hemoglobin decreased to less than 7.0 mg/dL or if anemic symptoms developed, such as a decrease in blood pressure to less than 100 mmHg, tachycardia greater than 100 beats/minute, or a low urine output less than 30 mL/hour, even after volume replacement with 500 mL normal saline in patients with a hemoglobin level between 7.0 and 8.0 mg/dL [29,32]. Allogenic transfusion was not performed when the hemoglobin level was greater than 8.0 mg/dL.…”

Section: Methodsmentioning

confidence: 99%

“…Substantial bleeding may occur at intraarticular and subcutaneous sites after TKA [11,17,24,32,40,43], and this can result in blood transfusion, which has been associated with many complications [5,6]. In addition, excessive bleeding may lead to intraarticular or subcutaneous hematoma formation, which can impair wound healing, restrict mobilization, and increase the risk of deep infection [18,22,31].…”

Section: Introductionmentioning

confidence: 99%

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Subcutaneous versus Intraarticular Indwelling Closed Suction Drainage after TKA: A Randomized Controlled Trial

Seo

Yoon

Koh

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background TKA can involve substantial bleeding, and the issue regarding whether vacuum drainage should be used during TKA continues to be debated as both methods have disadvantages. Questions/purposes We therefore asked whether subcutaneous indwelling vacuum drainage is advantageous over intraarticular indwelling vacuum drainage in terms of blood drainage, bleeding-related complications, and functional outcomes in primary TKA. Patients and methods We randomized 111 patients undergoing TKAs to have either a subcutaneous indwelling or an intraarticular indwelling catheter and compared the two groups for blood loss (hemoglobin decrease, transfusion requirements, hypotension episode), incidence of wound problems (requirements for dressing reinforcement,

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Subcutaneous versus Intraarticular Indwelling Closed Suction Drainage after TKA: A Randomized Controlled Trial

Seo

Yoon

Koh

et al. 2010

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…Previously, preoperative blood conservation algorithms have been able to decrease transfusions after TJA [16]. Many advances in the medical field, including the development of data registries, are becoming more readily available to assist in improvements.…”

Section: Discussionmentioning

confidence: 99%

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative

Markel

Allen

Zappa

2016

Clinical Orthopaedics &Amp; Related Research

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Background Standardized care plans are effective at controlling cost and quality. Registries provide insights into quality and outcomes for use of implants, but most registries do not combine implant and care quality data. In 2012, several Michigan area hospitals and a major insurance provider formed a voluntary statewide total joint database/registry, the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), to collect procedural, hospital, discharge, and readmission data. Noting substantial variation in transfusion practices after total joint arthroplasty (TJA) in our institutions, we used these prospectively collected data to examine whether awareness and education of the American Association of Blood Banks' (AABB) transfusion guidelines would result in decreased transfusions. Questions/purposes (1) Can an established arthroplasty registry help implement a quality initiative (QI) designed to decrease the proportion of transfused postoperative patients undergoing TJA? (2) Do data-driven transfusion protocols decrease length of stay without increasing ischemic complications (myocardial infarctions and cerebrovascular accidents)? (3) Are decreased transfusion proportions associated with decreased readmissions, nonischemic morbidity (including deep vein thrombosis and deep prosthetic infection), and mortality in postoperative patients who had undergone TJA? Methods After reviewing data from the recently established MARCQI registry, the orthopaedic department noticed many discrepancies and practice variances regarding blood transfusions among their providers. In October 2013, a QI was implemented to raise awareness of the discrepancies and education about the AABB guidelines was presented at the monthly orthopaedic service line meeting. A total of 1872 TJA cases were reviewed; 50 were excluded for incomplete data and two for intraoperative transfusions for the period before education (May 2012 to June 2013, n = 1240) and after education (November 2013 to April 2014, n = 580). Data collected included gender, age, length of stay, body mass index, preoperative hemoglobin level, lowest postoperative hemoglobin level during admission, transfusion status, number of units transfused, ischemic and nonischemic morbidity, hospital One or more of the authors (DCM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Stryker (Kalamazoo, MI, USA), Arboretum Ventures (Ann Arbor, MI, USA), Novi Bone and Joint (Novi, MI, USA), and CORE (Southfield, MI, USA). One or more of the authors (DCM) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Stryker and the Orthopaedic Research and Education Foundation (Rosemont, IL, USA) in the amount of USD 100,001 to USD 1,000,000. All ICMJE Conflict of Interest Forms for authors a...

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“…14 A conceptually simpler strategy (administration of erythropoietin in anyone expected to be rendered to a Hb of \ 7.0 gÁL -1 by subtracting a standardized procedure-specific predicted blood loss from his or her pre-operative hemoglobin) still yielded almost sixfold reductions in allogeneic transfusions. 15 Although the control group's transfusion rates in that investigation were very low to begin with, their decision to use protocol non-compliers as the control group will not find universal approval. Other strategies have reduced allogeneic transfusion rates in TJA successfully.…”

Section: Discussionmentioning

confidence: 97%

Réduction des transfusions sanguines allogènes grâce à un protocole basé sur le risque dans les cas d’arthroplastie avec prothèse totale

Rashiq

Jamieson-Lega

Komarinski

et al. 2010

Can J Anesth/J Can Anesth

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Purpose To evaluate the effect of a preoperative protocol that triages patients awaiting total joint arthroplasty to one of four strategies designed to mitigate the risk of allogeneic blood transfusion (ABT) based on a priori transfusion risk on perioperative exposure to allogeneic blood. Methods We compared the transfusion experiences of a historical control series of 160 subjects with a study group of 160 subjects treated by protocol. Protocol subjects with hemoglobin (Hb) 100-129 gÁL -1 were given erythropoietin, dosed by weight. Subjects with Hb 130-139 gÁL -1 underwent preoperative autologous blood harvest and perioperative re-infusion as deemed clinically necessary. Subjects with Hb [139 gÁL -1 received no special intervention, unless they were aged[70 yr and weighed\70 kg, in which case they received oral iron and folate supplementation. Results The relative risk of ABT in the Study group was 0.68 (95% confidence interval 0.54-0.85). The Control group received 104 units of allogeneic blood and the Study group received 35 units (P = 0.0007). These differences cannot be explained by differences in transfusion risk or autologous units transfused. There was no worsening of anemia or its consequences in the Study group. Conclusion A simple protocol based on easily obtained preoperative clinical indices effectively targets interventions that mitigate the risk of ABT. RésuméObjectif Nous avons voulu e´valuer l'effet d'un protocole pre´ope´ratoire re´partissant les patients devant subir une arthroplastie totale afin qu'ils suivent l'une de quatre strate´gies dans le but de diminuer le risque de transfusion de sang alloge`ne (TSA) selon leur risque a priori de transfusion sur l'exposition pe´riope´ratoire a`du sang alloge`ne. Méthode Nous avons compare´les expe´riences de transfusion d'une se´rie historique de cas te´moins compose´e de 160 patients a`un groupe d'e´tude de 160 patients traite´s sur la base de notre protocole. Les patients de notre protocole pre´sentant un taux d'he´moglobine (Hb) de 100-129 gÁL -1 ont reçu de l'e´rythropoı¨e´tine, dose´e en fonction de leur poids. Les patients ayant une Hb de 130-139 gÁL -1 ont subi une re´colte pre´ope´ratoire et une re-perfusion pe´riope´ratoire de sang autologue lorsque cela a éte´juge´ne´cessaire d'un point de vue clinique. Les patients ayant une Hb [139 gÁL -1 n'ont pas fait l'objet d'une intervention spe´ciale, sauf s'ils e´taient aˆge´s de[ 70 ans et pesaient \ 70 kg; dans ce cas, ils ont reçu des supple´ments de fer et d'acide folique par voie orale. Résultats Le risque relatif de TSA dans le groupe a`l'e´tude e´tait de 0,68 (intervalle de confiance 95 %, 0,54-0,85). Le groupe te´moin a reçu 104 unite´s de sang alloge`ne, contre 35 dans le groupe a`l'e´tude (P = 0,0007). Ces diffe´rences ne peuvent s'expliquer par des diffe´rences au niveau du risque

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A Blood-Conservation Algorithm to Reduce Blood Transfusions After Total Hip and Knee Arthroplasty

Cited by 112 publications

References 39 publications

Subcutaneous versus Intraarticular Indwelling Closed Suction Drainage after TKA: A Randomized Controlled Trial

Subcutaneous versus Intraarticular Indwelling Closed Suction Drainage after TKA: A Randomized Controlled Trial

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative

Réduction des transfusions sanguines allogènes grâce à un protocole basé sur le risque dans les cas d’arthroplastie avec prothèse totale

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