Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 2)

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.0000000000000135

Cited by 48 publications

(17 citation statements)

References 17 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: 64%

“…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: 64%

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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“…One key issue that has contributed greatly to the expansion and growth of PBM programs in health-care facilities is that they have been shown to be cost-effective in many of the implemented measures, although not all of them are [21]. An indicator of the interest that exists among professionals in the field of blood banking and transfusion is that the 2013 annual meeting of the American Association of Blood Banks (AABB), held in Denver, organized a pre-meeting full-day workshop about PBM programs.…”

Section: Patient Blood Managementmentioning

confidence: 99%

Transfusion medicine as of 2014

Lozano¹,

Cid²

2014

F1000Prime Rep

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Transfusion of blood components is one of the most common medical treatments, and in spite of the time that has evolved since we started to transfuse blood routinely in the 1930s, there are issues associated with its use that we are still trying to improve. Issues such as when to transfuse and adverse effects associated with the transfusion are fields where new evidence is being generated that ideally should help us to indicate when and what to transfuse to the patients. The recognition that the evidence generated in randomized control trials was not widely applied to guide the indication of the transfusion of blood components has provoked the development of initiatives that try to reduce its unnecessary usage. Those initiatives, grouped under the name of patient blood management, have represented a significant paradigm change, and a growing number of activities in this field are performed in health-care facilities around the world. This article tries to summarize the latest publications in those fields.

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“…In addition, large, multicenter randomized controlled trials showed that IBS during primary hip or knee replacement surgery did not decrease the mean number of allogeneic RBCs transfused or the proportion of patients receiving transfusions after surgery. [ 5 – 7 ]…”

Section: Introductionmentioning

confidence: 99%

Intraoperative blood salvage may shorten the lifespan of red blood cells within 3 days postoperatively

Liao

Zuo

Meng³

et al. 2017

Medicine

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Background:Intraoperative blood salvage (IBS) recovers most lost blood, and is widely used in the clinic. It is unclear why IBS does not reduce long-term postoperative requirements for red blood cells (RBCs), and 1 possibility is that IBS affects RBC lifespan.Methods:Prospectively enrolled patients who underwent spine, pelvic, or femur surgery not involving allogeneic RBC transfusion were grouped based on whether they received IBS or not. Volumes of blood lost and of RBCs salvaged during surgery were recorded. Total blood cell counts, levels of plasma-free hemoglobin, and CD235a-positive granulocytes were determined perioperatively.Results:Although intraoperative blood loss was higher in the IBS group (n = 45) than in the non-IBS group (n = 52) (P < .001), hemoglobin levels were similar between groups (P = .125) at the end of surgery. Hemoglobin levels increased in non-IBS patients (4 ± 11 g/L), but decreased in IBS patients (−7 ± 12 g/L) over the first 3 postoperative days. Nadir hemoglobin levels after surgery were higher in the non-IBS group (107 ± 12 g/L) than in the IBS group (91 ± 12 g/L). Salvaged RBC volume correlated with hemoglobin decrease (r = 0.422, P = .004). In multivariate analysis, salvaged RBC volume was an independent risk factor for hemoglobin decrease (adjusted odds ratio 1.002, 95% confidence interval 1.001–1.004, P = .008). Flow cytometry showed the numbers of CD235a-positive granulocytes after surgery to be higher in the IBS group than in the non-IBS group (P < .05).Conclusion:IBS may shorten the lifespan of RBCs by triggering their engulfment upon re-infusion (China Clinical Trial Registry ChiCTR-OCH-14005140).

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Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 2)

Abstract: In patients with preoperative hemoglobin levels greater than 13 g/dl, autologous intra- and postoperative blood salvage devices were not effective as transfusion alternatives: use of these devices did not reduce erythrocyte use and increased costs.

Cited by 48 publications

References 17 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

Transfusion medicine as of 2014

Intraoperative blood salvage may shorten the lifespan of red blood cells within 3 days postoperatively

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