Application of an adjusted patient blood management protocol in patients undergoing elective total hip arthroplasty: towards a zero-percent transfusion rate in renal patients—results from an observational cohort study

Hourlier, Hervé; Fennema, Peter

doi:10.1186/s13018-021-02846-z

Cited by 5 publications

(5 citation statements)

References 36 publications

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“…Perioperative TXA use is a clinically and cost-effective method for reducing blood loss during THA [ 6 , 31 , 32 ]. Our results showed that the use of TXA was associated with an 83% decreased risk of transfusion, which is consistent with previous findings [ 6 , 8 , 23 , 31 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Consistent with previous reports, we found that a lower preoperative hemoglobin level was associated with a high risk of transfusion [ 7 – 9 , 19 , 20 , 22 – 25 , 33 , 35 ]. Preoperative anemia is a modifiable risk factor for blood transfusion and other postoperative complications [ 32 , 33 ]. Klement et al reported that preoperative hemoglobin levels of 12.5 g/dL for women and 13.5 g/dL for men comprised the optimal cutoff values to predict the need for transfusion [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

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Predisposing factors for allogeneic blood transfusion in patients with ankylosing spondylitis undergoing primary unilateral total hip arthroplasty: a retrospective study

et al. 2023

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Background The transfusion rate is relatively high in patients with ankylosing spondylitis (AS) undergoing total hip arthroplasty (THA). However, relevant studies focusing on the predisposing factors for transfusion with a large sample size are lacking. This study aimed to investigate the incidence of and risk factors for allogeneic blood transfusion in patients with AS undergoing primary unilateral THA. Methods This retrospective study included 331 patients with AS who underwent primary unilateral THA between 2011 and 2021. Relevant parameters were collected through a chart review. Multivariate logistic regression analysis was conducted to identify possible factors associated with perioperative allogeneic blood transfusion. Results A total of 113 (34.1%) patients received perioperative allogeneic blood transfusions. Factors related to receiving an allogeneic blood transfusion included prolonged operative duration (odds ratio [OR] per 10 min = 1.139, P = 0.047), increased estimated intraoperative blood loss (OR per 100 mL = 1.348, P < 0.001), and increased postoperative drainage volume (OR per 100 mL = 1.235, P = 0.024). A higher body mass index (BMI) (OR = 0.914, P = 0.012), perioperative tranexamic acid (TXA) use (OR = 0.166, P < 0.001), and a higher preoperative hemoglobin level (OR per 1 g/dL = 0.744, P = 0.004) decreased the risk of transfusion. Conclusions In patients with AS undergoing THA, prolonged operative duration, increased estimated intraoperative blood loss, and increased postoperative drainage volume were found to be risk factors for transfusion, whereas a higher BMI, perioperative TXA use, and a higher preoperative hemoglobin level were protective factors. These results may aid in developing a better perioperative management strategy, ultimately reducing the need for transfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predisposing factors for allogeneic blood transfusion in patients with ankylosing spondylitis undergoing primary unilateral total hip arthroplasty: a retrospective study

et al. 2023

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“…Chronic kidney disease (CDK) was not assessed in this study as a possible confounder. Though, recent studies showed no negative effects on transfusion rates in an adjusted PBM protocol for patients [ 28 ]. There were no major bleeding events found in our complication records for the study period, so a possible influence on transfusion rate can be ruled out.…”

Section: Discussionmentioning

confidence: 99%

Cemented and hybrid total hip arthroplasty lead to lower blood loss in primary total hip arthroplasty: a retrospective study

Meißner

Halder

Schrednitzki

2023

Arch Orthop Trauma Surg

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Background Little scientific evidence exists on blood loss and transfusion rates depending on the fixation technique. The hypothesis of this study was that the blood loss and transfusion rate are lower in cemented and hybrid total hip arthroplasty (THA) compared to cementless THA. Methods We retrospectively compared a total of 1500 patients who received either cementless, cemented, hybrid or reverse hybrid THA. All patients underwent THA in 2021 at a single orthopedic center in Germany. Results The lowest blood loss was found in patients who received a fully cemented THA (695 ± 74 ml). Hybrid THA with a cemented stem showed a blood loss of 845 ± 30 ml and reverse hybrid THA showed the highest blood loss with an average of 994 ± 74 ml. Cementless THA caused an average blood loss of 957 ± 16 ml. There was a significant difference between cementless THA, hybrid THA (cemented stem), and fully cemented THA ( p < 0.05). Transfusion rates ranged from 1.3% (cementless THA) to 7.9% (cemented THA) between the groups with a transfusion rate of 2.5% overall. Conclusion We found significantly lower blood loss in cemented THA and hybrid THA compared to cementless THA. Although blood loss was lower in cemented and hybrid THA, this did not result in lower transfusion rates. This could be due to other confounders such as age, comorbidities, and preoperative anemia.

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“…Recently, we reported on the effectiveness and safety of this adjusted PBM in a large cohort of patients who underwent elective total hip arthroplasty, including patients with renal impairment who are considered at risk for transfusion during the TJA procedure [ 11 ]. Here, we report on the outcomes of this adjusted surgical PBM in patients undergoing primary unilateral TKA with preoperative anemia.…”

Section: Introductionmentioning

confidence: 99%

An observational study of an adjusted patient blood management protocol intended to lower rates of transfusion following total knee arthroplasty in patients with preoperative anemia

Hourlier,

Fennema

2023

J Orthop Surg Res

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Background Patients with preoperative anemia have a higher risk of requiring blood transfusion after major orthopedic surgery due to increased blood loss and closer transfusion thresholds. Various patient blood management (PBM) policies aim to reduce transfusion rates. This observational study aimed to investigate blood loss and evaluate the effectiveness of an adjusted surgical PBM protocol in patients with anemic chronic disease (ACD) undergoing elective total knee arthroplasty (TKA). Methods A consecutive cohort of patients underwent elective unilateral TKA with an adjusted PBM protocol. The protocol consisted of epoetin (EPO) alfa therapy prescribed by the surgeon, routine administration of tranexamic acid (TXA), and standardized postoperative pharmacologic prophylaxis for thromboembolism. The performance of this PBM protocol was analyzed in patients with a baseline hemoglobin level of less than 12 g/dl. Hemoglobin levels were controlled at admission, on postoperative day (POD) 1, and on POD 7 ± 1. A bleeding index (BI-7) was used as an estimate of blood loss up until POD 7. Multiple linear regression was used to assess whether there were any differences in BI-7 between ACD– and ACD + patients. Results A total of 751 patients with complete hemoglobin monitoring were included in the study. Of these patients, 68 (9.1%) had a baseline hemoglobin concentration of less than 12 g/dl (ACD group). In this group, 28 patients (41.2%) received preoperative EPO therapy. The mean adjusted BI-7 for the study population was 3.0 (95% CI, 2.9 to 3.0) g/dl in the ACD– group and 2.3 (95% CI, 2.0–2.6) g/dl in the ACD + group. The difference in BI-7 was statistically significant (difference, 0.6 [95% CI: 0.3 to 0.9] g/dl, p < 0.001). No major complications occurred in the ACD + group, whereas there were three complications in the ACD– group (p = 1.00). Conclusions ACD patients undergoing TKA did not have an increased risk of bleeding or bleeding complications with the use of the adjusted PBM protocol. None of ACD patients required transfusion. ACD patients undergoing TKA experienced significantly less blood loss than patients with no preoperative anemia with the use of the adjusted PBM. We now consider the use of EPO in ACD patients with no nutritional deficiencies undergoing TKA at a baseline hemoglobin level of 11 g/dl. However, this should be validated in larger cohorts with a higher prevalence of ACD patients.

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Application of an adjusted patient blood management protocol in patients undergoing elective total hip arthroplasty: towards a zero-percent transfusion rate in renal patients—results from an observational cohort study

Cited by 5 publications

References 36 publications

Predisposing factors for allogeneic blood transfusion in patients with ankylosing spondylitis undergoing primary unilateral total hip arthroplasty: a retrospective study

Predisposing factors for allogeneic blood transfusion in patients with ankylosing spondylitis undergoing primary unilateral total hip arthroplasty: a retrospective study

Cemented and hybrid total hip arthroplasty lead to lower blood loss in primary total hip arthroplasty: a retrospective study

An observational study of an adjusted patient blood management protocol intended to lower rates of transfusion following total knee arthroplasty in patients with preoperative anemia

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