Minimizing Blood Transfusion in Total Hip and Knee Arthroplasty Through a Multimodal Approach

Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

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Psychopharmacologic treatment and blood transfusion in fast-track total hip and knee arthroplasty

Transfusion ◽

10.1111/trf.13992 ◽

2017 ◽

Vol 57 (4) ◽

pp. 971-976 ◽

Cited By ~ 3

Author(s):

Silas Hinsch Gylvin ◽

Christoffer Calov Jørgensen ◽

Anders Fink-Jensen ◽

Pär I. Johansson ◽

Henrik Kehlet ◽

...

Keyword(s):

Blood Transfusion ◽

Knee Arthroplasty ◽

Fast Track ◽

Total Hip ◽

Hip And Knee Arthroplasty

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Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty

Journal of Personalized Medicine ◽

10.3390/jpm11111223 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1223

Author(s):

Axel Jakuscheit ◽

Nina Schaefer ◽

Johannes Roedig ◽

Martin Luedemann ◽

Sebastian Philipp von Hertzberg-Boelch ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Transfusion ◽

Knee Arthroplasty ◽

Haemoglobin Concentration ◽

Blood Transfusions ◽

Preoperative Treatment ◽

Complication Rates ◽

Total Hip ◽

Hip And Knee Arthroplasty ◽

Low Bmi

Background: The primary aim of this study was to identify modifiable patient-related predictors of blood transfusions and perioperative complications in total hip and knee arthroplasty. Individual predictor-adjusted risks can be used to define preoperative treatment thresholds. Methods: We performed this retrospective monocentric study in orthopaedic patients who underwent primary total knee or hip arthroplasty. Multivariate logistic regression models were used to assess the predictive value of patient-related characteristics. Predictor-adjusted individual risks of blood transfusions and the occurrence of any perioperative adverse event were calculated for potentially modifiable risk factors. Results: 3754 patients were included in this study. The overall blood transfusion and complication rates were 4.8% and 6.4%, respectively. Haemoglobin concentration (Hb, p < 0.001), low body mass index (BMI, p < 0.001) and estimated glomerular filtration rate (eGFR, p = 0.004) were the strongest potentially modifiable predictors of a blood transfusion. EGFR (p = 0.001) was the strongest potentially modifiable predictor of a complication. Predictor-adjusted risks of blood transfusions and acute postoperative complications were calculated for Hb and eGFR. Hb = 12.5 g/dL, BMI = 17.6 kg/m2, and eGFR = 54 min/mL were associated, respectively, with a 10% risk of a blood transfusion, eGFR = 59 mL/min was associated with a 10% risk of a complication. Conclusion: The individual risks for blood transfusions and acute postoperative complications are strongly increased in patients with a low preoperative Hb, low BMI or low eGFR. We recommend aiming at a preoperative Hb ≥ 13g/dL, an eGFR ≥ 60 mL/min and to avoid a low BMI. Future studies must show if a preoperative increase of eGFR and BMI is feasible and truly beneficial.

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Efficacy and Cost Effectiveness of Universal Preoperative Iron Studies in Total Hip and Knee Arthroplasty

10.21203/rs.3.rs-441489/v1 ◽

2021 ◽

Author(s):

Viju Daniel Varghese ◽

David Liu ◽

Donald Ngo ◽

Suzanne Edwards

Keyword(s):

Blood Transfusion ◽

Knee Arthroplasty ◽

Universal Screening ◽

Intravenous Iron ◽

Allogenic Blood Transfusion ◽

Transfusion Rate ◽

Allogenic Blood ◽

Total Hip ◽

Hip And Knee Arthroplasty ◽

The Difference

Abstract Background Prevalence of anaemia in patients planned for total hip and knee arthroplasty is about 20%. Optimising preoperative haemoglobin levels by iron supplementation has been shown to decrease transfusion rates, complications and associated morbidity. The need for universal screening with iron studies of all elective arthroplasty patients is not clearly defined at present. Methods Retrospective review of 2 sequential cohorts of patients undergoing primary hip or knee arthroplasty by a single surgeon at a single centre between January 2013 and December 2017. The first group of patients underwent pre-operative iron studies only if found to be anaemic, with a haemoglobin below 12g/dL. From January 2015 all patients irrespective of the presence of anaemia were screened with a complete iron profile before surgery. Patients with a confirmed iron deficiency were administered with intravenous iron prior to surgery. The 2 cohorts were compared with regards to blood transfusion rate post-operatively and cost efficiency for universal screening with iron studies. Results There was a net decrease in allogenic blood transfusion rate from 4.76–2.92% when universal iron studies were introduced but the difference was not statistically significant. Obtaining universal pre-operative iron studies is cost neutral with the price of allogenic blood transfusion in a similar cohort. We also diagnosed 5 patients with occult malignancies. Conclusions Universal screening with pre-operative iron studies and iron infusion in elective arthroplasty patients may reduce allogenic blood requirements and is cost neutral. An additional benefit is the potential to diagnose asymptomatic malignancies. Further studies are required to show the true benefit of universal pre-operative iron screening.

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