{"title":"Blood management protocol for baseline anemic patients undergoing hip arthroplasty.","authors":"Hervé Hourlier, Guillaume Fricault, Peter Fennema","doi":"10.1007/s00402-025-05764-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Patients undergoing total hip arthroplasty (THA) with preoperative anemia are at higher risk for transfusion. Blood-conserving interventions can reduce perioperative transfusions. This retrospective study evaluates the efficacy and safety of a patient blood management (PBM) protocol in elective primary THA patients with preoperative anemia.</p><p><strong>Materials and methods: </strong>We analyzed data from a prospectively collected database of THAs performed consecutively from January 2013 to October 2023. The patients were grouped based on baseline hemoglobin (Hb) levels, as follows: <12 g/dL (group 1) and ≥ 12 g/dL (group 2). The PBM protocol included optimized preoperative epoetin (EPO) for Hb < 11 g/dL, bleeding reduction measures, and restrictive transfusion thresholds. Blood loss was measured using a bleeding index (BI-7), accounting for Hb decrease from admission to the 7th postoperative day and total transfused units. Multiple linear regression was used to assess the differences in BI-7.</p><p><strong>Results: </strong>Of the 1,442 patients, 104 (7%) had Hb < 12 g/dL (group 1). Among these, 46 (45%) received EPO, with none requiring transfusion in the first week. The mean adjusted BI-7 was 2.3 g/dL (95% CI, 2.1 to 2.6) in group 1 and 2.7 g/dL (95% CI, 2.6 to 2.7) in group 2, showing a significant difference (-0.4 g/dL; 95% CI, -0.6 to -0.1; p < 0.001).</p><p><strong>Conclusions: </strong>THA patients with baseline Hb < 12 g/dL had a zero-transfusion rate and significantly lower blood loss than those with Hb ≥ 12 g/dL. Optimizing preoperative Hb levels above 12 g/dL is not necessary for patients undergoing standard THA. Optimizing preoperative Hb may not be necessary for patients with baseline anemia due to their low blood loss. The PBM protocol was effective in conserving blood, time, and resources, offering a viable alternative for blood conservation in elective hip arthroplasty.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"143"},"PeriodicalIF":2.0000,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Orthopaedic and Trauma Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00402-025-05764-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Patients undergoing total hip arthroplasty (THA) with preoperative anemia are at higher risk for transfusion. Blood-conserving interventions can reduce perioperative transfusions. This retrospective study evaluates the efficacy and safety of a patient blood management (PBM) protocol in elective primary THA patients with preoperative anemia.
Materials and methods: We analyzed data from a prospectively collected database of THAs performed consecutively from January 2013 to October 2023. The patients were grouped based on baseline hemoglobin (Hb) levels, as follows: <12 g/dL (group 1) and ≥ 12 g/dL (group 2). The PBM protocol included optimized preoperative epoetin (EPO) for Hb < 11 g/dL, bleeding reduction measures, and restrictive transfusion thresholds. Blood loss was measured using a bleeding index (BI-7), accounting for Hb decrease from admission to the 7th postoperative day and total transfused units. Multiple linear regression was used to assess the differences in BI-7.
Results: Of the 1,442 patients, 104 (7%) had Hb < 12 g/dL (group 1). Among these, 46 (45%) received EPO, with none requiring transfusion in the first week. The mean adjusted BI-7 was 2.3 g/dL (95% CI, 2.1 to 2.6) in group 1 and 2.7 g/dL (95% CI, 2.6 to 2.7) in group 2, showing a significant difference (-0.4 g/dL; 95% CI, -0.6 to -0.1; p < 0.001).
Conclusions: THA patients with baseline Hb < 12 g/dL had a zero-transfusion rate and significantly lower blood loss than those with Hb ≥ 12 g/dL. Optimizing preoperative Hb levels above 12 g/dL is not necessary for patients undergoing standard THA. Optimizing preoperative Hb may not be necessary for patients with baseline anemia due to their low blood loss. The PBM protocol was effective in conserving blood, time, and resources, offering a viable alternative for blood conservation in elective hip arthroplasty.
期刊介绍:
"Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance.
"Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).