Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 1)

So‐Osman, Cynthia; Nelissen, Rob G H H; Gemert, A.W.M.M. Koopman-van; Kluyver, Ewoud; Pöll, Ruud G.; Onstenk, Ron; Hilten, J. A. van; Jansen-Werkhoven, Thekla M.; Hout, Wilbert B. van den; Brand, Ronald; Brand, Anneke

doi:10.1097/aln.0000000000000134

Cited by 95 publications

(23 citation statements)

References 29 publications

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“…It was thus concluded that EPO and perioperative blood salvage were not cost-effective in primary elective THA and TKA. For the use of EPO and perioperative blood salvage in revision THA and TKA no conclusions about the (cost-) effectiveness could be drawn [18,19]. These results are in line with recent literature.…”

Section: Introductionsupporting

confidence: 65%

“…This study is the next step following a RCT on EPO and perioperative blood salvage as transfusion alternatives in THA and TKA using a restrictive transfusion policy, showing that use of these BSMs is not cost-effective [18,19], and a study in which a tailored de-implementation strategy was systematically developed [25,30,34]. Given the large number of THA and TKA performed annually in the Netherlands and worldwide, de-implementation of non-cost effective BSMs contributes to more efficient healthcare.…”

Section: Discussionmentioning

confidence: 99%

“…When the costs of these techniques are considered, the use of EPO and perioperative blood salvage becomes controversial [8,11-17]. A large multicenter Randomized Controlled Trial (RCT) was recently performed to test the effectiveness and cost-effectiveness of EPO and perioperative blood salvage in elective THA and TKA [18,19]. It was shown that perioperative blood salvage in primary THA and TKA neither resulted in a decreased mean number of allogeneic blood units nor in a decrease in the proportion of transfused patients, and was more expensive due to the costs of the device and a prolonged hospital stay.…”

Section: Introductionmentioning

confidence: 99%

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De-implementation of expensive blood saving measures in hip and knee arthroplasties: study protocol for the LISBOA-II cluster randomized trial

et al. 2014

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BackgroundDespite evidence that erythropoietin and intra- and postoperative blood salvage are expensive techniques considered to be non-cost-effective in primary elective total hip and knee arthroplasties in the Netherlands, Dutch medical professionals use them frequently to prevent the need for allogeneic transfusion. To actually change physicians’ practice, a tailored strategy aimed at barriers that hinder physicians in abandoning the use of erythropoietin and perioperative blood salvage was systematically developed. The study aims to examine the effectiveness, feasibility and costs of this tailored de-implementation strategy compared to a control strategy.Methods/DesignA cluster randomized controlled trial including an effect, process and economic evaluation will be conducted in a minimum of 20 Dutch hospitals. Randomisation takes place at hospital level. The hospitals in the intervention group will receive a tailored de-implementation strategy that consists of four components: interactive education, feedback in educational outreach visits, electronically sent reports on hospital performance (all aimed at orthopedic surgeons and anesthesiologists), and information letters or emails aimed at other involved professionals within the intervention hospital (transfusion committee, OR-personnel, pharmacists). The hospitals in the control group will receive a control strategy (i.e., passive dissemination of available evidence). Outcomes will be measured at patient level, using retrospective medical record review. This will be done in all hospitals at baseline and after completion of the intervention period. The primary outcome of the effect evaluation is the percentage of patients undergoing primary elective total hip or knee arthroplasty in which erythropoietin or perioperative blood salvage is applied. The actual exposure to the tailored strategy and users’ experiences will be assessed in the process evaluation. In the economic evaluation, the costs of the tailored strategy and the control strategy in relation to the difference in their effectiveness will be compared.DiscussionThis study will show whether a systematically developed tailored strategy is more effective for de-implementation of non-cost-effective blood saving measures than the control strategy. This knowledge can be used in national and international initiatives to make healthcare more efficient. It also provides more generalized knowledge regarding de-implementation strategies.Trial registrationThis trial is registered at the Dutch Trial Register NTR4044.

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Section: Introductionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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De-implementation of expensive blood saving measures in hip and knee arthroplasties: study protocol for the LISBOA-II cluster randomized trial

et al. 2014

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“…Its role in blood loss management has been thoroughly studied, showing a 60% reduction of ABTs in patients who received EPO compared to control group[28-30]. Three or four weekly subcutaneous injections (600 IU/kg) seems to be the most frequently used protocol with the best results[31-35]. Weber et al[36] reports a mean rise in pre-operative Hb of 1.9 g/dL in patients that received EPO.…”

Section: Pre-operativementioning

confidence: 99%

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Themistoklis¹,

Vogiatzaki²,

Kazakos³

et al. 2017

WJO

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Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.

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“…Recently, some studies have found that it was little or no advantage. So-Osman et al 2 found that there was no significant increase in hemoglobin level after total knee arthroplasty in the IBS group, and it could not reduce the transfusion of allogeneic blood. Other studies also reported that IBS did not reduce the rate of allogeneic blood transfusion and the volume of blood transfusion 3 days postoperatively.…”

Section: Introductionmentioning

confidence: 97%

Risk Factors for the Postoperative Transfusion of Allogeneic Blood in Orthopedics Patients With Intraoperative Blood Salvage

et al. 2016

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The purpose of this study is to explore the risk factors affecting the postoperative transfusion of allogeneic blood in patients undergoing orthopedics surgery with intraoperative blood salvage (IBS). A retrospective study of 279 patients undergoing orthopedic surgeries with IBS from May 2013 to May 2015 was enrolled. The binary logistic regression was used to find out the risk factors associated with postoperative transfusion of allogeneic blood in orthopedics patients with IBS, and then receiver operating characteristic (ROC) curve was drawn to determine the optimal threshold of the regression model.Single factor analysis showed that age, American Society of Anesthesiologists (ASA) grade, preoperative hemoglobin, operation time, received autologous blood, the laying time of autologous blood, bleeding volume, and postoperative drainage volume had significant effects on postoperative allogeneic blood transfusion.In binary logistic regression analysis, the independent factors predicting orthopedic patients with IBS need to transfuse allogeneic blood after surgeries were age (odds ratio [OR] = 0.415, P = 0.006), ASA grade (OR = 2.393, P = 0.035), preoperative hemoglobin (OR = 0.532, P = 0.022), and postoperative drainage volume (OR = 4.279, P = 0.000). The area under ROC curve was 0.79 and the predicted accuracy rate of the model was 81.58%.After operation, the orthopedic patients with IBS still have a high allogeneic blood transfusion rate, and IBS is not a perfect blood protection method. The logistic regression model of our study provides a reliable prediction for postoperative transfusion of allogeneic blood in orthopedic patients with IBS, which have a certain reference value.

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Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 1)

Abstract: In hip- and knee-replacement patients (hemoglobin level, 10 to 13 g/dl), even with a restrictive transfusion trigger, erythropoietin significantly avoids transfusion, however, at unacceptably high costs. Autologous blood salvage devices were not effective.

Cited by 95 publications

References 29 publications

De-implementation of expensive blood saving measures in hip and knee arthroplasties: study protocol for the LISBOA-II cluster randomized trial

De-implementation of expensive blood saving measures in hip and knee arthroplasties: study protocol for the LISBOA-II cluster randomized trial

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Risk Factors for the Postoperative Transfusion of Allogeneic Blood in Orthopedics Patients With Intraoperative Blood Salvage

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