Preoperative Erythropoietin Alpha Reduces Postoperative Transfusions in THA and TKA but May Not Be Cost-effective

Bedair, Hany; Yang, Judy P.; Dwyer, Maureen K.; McCarthy, Joseph C.

doi:10.1007/s11999-014-3819-z

Cited by 62 publications

(40 citation statements)

References 35 publications

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“…Nevertheless, and in spite of the differences between both studies, in ours, we did not detect any supplementary benefit in RBC transfusion reduction, in the subgroups of intracapsular HF, or in those patients with highest Hb levels (in our case those with inclusion Hb level ≥ 115 g/L). Data from our study also contrast with the established benefit of preoperative EPO and IV iron in patients undergoing elective major orthopedic procedures . Nevertheless, results obtained in the previous trials are difficult to extrapolate to patients with HF.…”

Section: Discussioncontrasting

confidence: 89%

Ferric carboxymaltose with or without erythropoietin in anemic patients with hip fracture: a randomized clinical trial

et al. 2016

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Section: Discussioncontrasting

confidence: 89%

Ferric carboxymaltose with or without erythropoietin in anemic patients with hip fracture: a randomized clinical trial

et al. 2016

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“…Previous authors have recommended preoperative autologous blood donation in TSA for patients with preoperative hemoglobin levels between 110 and 130 g/L [30]. In the setting of TKA and THA, various preoperative hemoglobin optimization strategies have been studied including autologous and allogeneic blood transfusion protocols, erythropoietin alpha, and tranexamic acid with varying degrees of success and cost-effectiveness [3,13,16,18,20,34,48]. Having used a large multicenter database, our study supports and extends previous results with our finding that a preoperative hematocrit \ 38% is an independent predictor of transfusion.…”

Section: Discussionmentioning

confidence: 99%

What Are Risk Factors for 30-day Morbidity and Transfusion in Total Shoulder Arthroplasty? A Review of 1922 Cases

Anthony

Westermann

Gao

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Total shoulder arthroplasty (TSA) is an effective treatment for end-stage glenohumeral joint pathology with good long-term results. Previous descriptions of morbidity and blood transfusion in TSA are limited by preoperative risk factors and postoperative complications considered and single-center studies. Questions/purposes The purpose of this study was to define in a group of patients undergoing TSA (1) the type and incidence of complications; (2) the frequency of and risk factors for both minor and major complications; and (3) the risk factors for bleeding resulting in transfusion. Methods We retrospectively queried the National Surgical Quality Improvement Program database using Current Procedural Terminology billing codes and identified 1922 cases of TSA performed between 2006 and 2011. Postoperative outcomes were divided into one of four categories: any complication, major morbidity (systemic life-threatening event or a substantial threat to a vital organ) or mortality, minor morbidity (localized to the operative upper extremity or not posing a major systemic threat to the patient), or bleeding resulting in transfusion. Univariate and multivariate analyses were then used to identify risk factors for complications.

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“…In an unrestricted transfusion standard study, Bedair et al . demonstrate that erythropoietin could increase the postoperative Hb level ( P < 0.001) and lower transfusion rates (0% vs 41%, P < 0.001) but increase healthcare costs ($2632 vs $2284). Another study found that erythropoietin reduced blood transfusion even under restrictive transfusion criteria.…”

Section: Preoperative Strategiesmentioning

confidence: 96%

Perioperative Blood Management Strategies for Total Knee Arthroplasty

Lü

Peng

Zhou

et al. 2018

Orthopaedic Surgery

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Total knee arthroplasty (TKA) often causes a significant amount of blood loss with an accompanying decline in hemoglobin and may increase the frequency of allogeneic blood transfusion rates. Unfortunately, allogeneic blood transfusions have associated risks including postoperative confusion, infection, cardiac arrhythmia, fluid overload, increased length of hospital stay, and increased mortality. Other than reducing the need for blood transfusions, reducing perioperative blood loss in TKA may also minimize intra-articular hemorrhage, limb swelling, and postoperative pain, and increase the range of motion during the early postoperative period. These benefits improve rehabilitation success and increase patients' postoperative satisfaction. Preoperative anemia, coupled with intraoperative and postoperative blood loss, is a major factor associated with higher rates of blood transfusion in TKA. Thus, treatment of preoperative anemia and prevention of perioperative blood loss are the primary strategies for perioperative blood management in TKA. This review, combined with current evidence, analyzes various methods of blood conservation, including preoperative, intraoperative, and postoperative methods, in terms of their effectiveness, safety, and cost. Because many factors can be controlled to reduce blood loss and transfusion rates in TKA, a highly efficient, safe, and cost-effective blood management strategy can be constructed to eliminate the need for transfusions associated with TKA.

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Preoperative Erythropoietin Alpha Reduces Postoperative Transfusions in THA and TKA but May Not Be Cost-effective

Abstract: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 62 publications

References 35 publications

Ferric carboxymaltose with or without erythropoietin in anemic patients with hip fracture: a randomized clinical trial

Ferric carboxymaltose with or without erythropoietin in anemic patients with hip fracture: a randomized clinical trial

What Are Risk Factors for 30-day Morbidity and Transfusion in Total Shoulder Arthroplasty? A Review of 1922 Cases

Perioperative Blood Management Strategies for Total Knee Arthroplasty

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