In the Era of Tranexamic Acid, are Type and Screens for Primary Total Joint Arthroplasty Obsolete?

Vestermark, George L.; Rowe, Taylor; Martin, John R.; Odum, Susan M.; Springer, Bryan D.; Fehring, Thomas K.

doi:10.1016/j.arth.2020.04.056

Cited by 12 publications

(15 citation statements)

References 30 publications

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“…To our knowledge, there are no studies specifically reviewing T&S data at academic medical centers serving a major metropolitan area. In this study, the overall transfusion rate was extremely low (1.06%) and consistent with recent data [8,11,23]. Tischler et al [8] compared the overall transfusion rate at a specialty surgical hospital (1.8%) with that at a university hospital (2.9%).…”

Section: Discussionsupporting

confidence: 90%

“…There has been extensive and compelling literature on TXA proving its efficacy of reducing blood loss and transfusion rates [9,[19][20][21][22][23]. Some institutions have implemented practice changes within the past few years, foregoing routine T&S in low-risk patients [8,11]. Notably, these studies occurred at a specialty surgical hospital [8] and a tertiary orthopaedic hospital [11].…”

Section: Discussionmentioning

confidence: 99%

“…Some institutions have implemented practice changes within the past few years, foregoing routine T&S in low-risk patients [8,11]. Notably, these studies occurred at a specialty surgical hospital [8] and a tertiary orthopaedic hospital [11]. To our knowledge, there are no studies specifically reviewing T&S data at academic medical centers serving a major metropolitan area.…”

Section: Discussionmentioning

confidence: 99%

“…However, recent postoperative transfusion rates in these patients suggest that this may be unnecessary. Studies have shown a decline in transfusion rates with some rates as low as 1%-2% with improved surgical techniques, presurgical optimization, and the implementation of various blood management protocols including the use of tranexamic acid (TXA) and changing transfusion thresholds [7][8][9][10][11]. Despite the decline seen in transfusion rates, T&S is still routinely ordered before these procedures.…”

Section: Introductionmentioning

confidence: 99%

“…With TKA and THA volumes expected to reach a combined 2 million cases annually by 2030 [16], these investigations have unearthed the potential to save nearly $200 per patient, resulting in hundreds of millions of cost savings annually. A prior study has shown omitting preoperative T&S to be both safe and cost-effective for primary TKA and THA [11]. Previous studies have focused on inpatient and surgical centers.…”

Section: Introductionmentioning

confidence: 99%

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Routine Type and Screens Are Unnecessary for Primary Total Hip and Knee Arthroplasties at an Academic Hospital

et al. 2020

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Background: Despite decreasing transfusion rates, routine type and screens are frequently used before primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). The aims of this study were to characterize transfusion rates and identify any factors that affect the likelihood of transfusion to determine if it is safe to discontinue routine preoperative type and screens at an academic hospital. Methods: A retrospective chart review was performed for all patients who underwent primary THA or TKA in 2019 at an academic institution by a fellowship-trained arthroplasty surgeon. Data on preoperative type and screens, transfusion rates, bleeding disorders, and anticoagulation status were obtained. Patients were considered to have a preoperative type and screen if it was performed within 30 days before surgery. Results: Overall, 379 patients were included in the study. Of these, 210 underwent primary THA and 169 underwent primary TKA. Four patients received transfusions during their hospitalization for a cumulative transfusion rate of 1.06%. No patients received an intraoperative transfusion. One (0.59%) patient received a postoperative transfusion after TKA, and 3 (1.43%) patients received a postoperative transfusion after THA. The mean preoperative hemoglobin of the 4 transfused patients was 10.8 g/dL. Conclusions: In summary, performing a preoperative routine type and screen is likely unnecessary at academic medical centers. Consideration for obtaining a type and screen may include complex primary surgeries or when patients have preoperative hemoglobin of less than 11 g/dL. Ultimately, preoperative type and screen should be considered on a case-by-case basis using clinical judgment.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Routine Type and Screens Are Unnecessary for Primary Total Hip and Knee Arthroplasties at an Academic Hospital

et al. 2020

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Associations of preoperative anemia and postoperative hemoglobin values with hospital costs in total knee arthroplasty (TKA)

Schatz¹,

Plötz²,

Beckmann³

et al. 2023

Arch Orthop Trauma Surg

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Background Total knee arthroplasty are among the most frequently conducted surgeries, due to an aging society. Since hospital costs are subsequently rising, adequate preparation of patients and reimbursement becomes more and more important. Recent literature revealed anemia as a risk factor for enhanced length of stay (LOS) and complications. This study analyzed whether preoperative hemoglobin (Hb) and postoperative Hb were associated with total hospital costs and general ward costs. Methods The study comprised 367 patients from a single high-volume hospital in Germany. Hospital costs were calculated with standardized cost accounting methods. Generalized linear models were applied to account for confounders, such as age, comorbidities, body mass index, insurance status, health-related quality of life, implant types, incision-suture-time and tranexamic acid. Results Preoperative anemic women had 426 Euros higher general ward costs (p < 0.01), due to increased LOS. For men, 1 g/dl less Hb loss between the preoperative value and the value before discharge reduced total costs by 292 Euros (p < 0.001) and 161 Euros fewer general ward costs (p < 0.001). Total hospital costs were reduced by 144 Euros with 1 g/dl higher Hb on day 2 postoperatively for women (p < 0.01). Conclusion Preoperative anemia was associated with increased general ward costs for women and Hb loss with decreasing total hospital costs for men and women. Cost containment, especially reduced utilization of the general ward, may be feasible with the correction of anemia for women. Postoperative Hb values may be a factor for adjustments of reimbursement systems. Level of evidence Retrospective cohort study, III.

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Routine pretransfusion testing before primary total hip or knee arthroplasty are an expensive and wasteful routine. Systematic review and meta-analysis

Nuñez,

Colomina,

Angles

et al. 2024

Arch Orthop Trauma Surg

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In the Era of Tranexamic Acid, are Type and Screens for Primary Total Joint Arthroplasty Obsolete?

Cited by 12 publications

References 30 publications

Routine Type and Screens Are Unnecessary for Primary Total Hip and Knee Arthroplasties at an Academic Hospital

Routine Type and Screens Are Unnecessary for Primary Total Hip and Knee Arthroplasties at an Academic Hospital

Associations of preoperative anemia and postoperative hemoglobin values with hospital costs in total knee arthroplasty (TKA)

Routine pretransfusion testing before primary total hip or knee arthroplasty are an expensive and wasteful routine. Systematic review and meta-analysis

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