A restrictive use of both autologous donation and recombinant human erythropoietin is an efficient policy for primary total hip or knee arthroplasty.
A limitation of preoperative autologous blood donation (PABD) in nonanemics and the use of recombinant human erythropoietin (EPO) in anemics (baseline hematocrit [Hct] < or = 39%) could be an efficient approach of the cost-benefit ratio of transfusion during primary total hip (THA) or knee (TKA) arthroplasties. We evaluated the consequences on transfusion rates and costs of two different applications of a transfusion policy based on personal requirements during primary THA or TKA. This quality assurance observational study compared two prospective successive time periods; each included successive patients treated by the same medical team and standardized care. In Study 1 (n = 182), PABD was indicated if there were insufficient estimated red blood cell reserve and a life expectancy > or = 10 yr, no use of EPO, and identical criteria for any transfusion. Because this policy led to a 50% allogeneic transfusion rate when baseline Hct < or = 37% and autologous blood wastage in the nonanemics (baseline Hct > 39%), 2 refinements were introduced in Study 2 (n = 708): EPO without PABD when baseline Hct < or = 37%, and life expectancy > or = 10 yr, and avoidance of PABD in nonanemics. This novel care induced a marked decrease in transfusion rates (respectively, from 41% to 7%, P < 0.0002, in nonanemics; from 58% to 27%, P < 0.003, in anemics; and from 43% to 12%, P < 0.0001, overall), with no change in allogeneic transfusion (10%) and discharge Hct, and a 39% financial savings. This saving effect is a result of the suppression of PABD in nonanemics, who represent 75% of this surgical population. Although erythropoietin is expensive, it can be used with cost savings in selected patients because the overall cost of transfusion is reduced.
Departments of *Anesthesiology and Critical Care and †Orthopedic Surgery, Trousseau University Hospital, Tours, France.
Claude
C
Couvret
Marc
M
Laffon
Annick
A
Baud
Valérie
V
Payen
Philippe
P
Burdin
Jacques
J
Fusciardi
D000368:Aged; D000740:Anemia / Q000453:epidemiology; D000758:Anesthesia; D019644:Arthroplasty, Replacement, Hip / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000191:economics; D001782:Blood Donors; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001804:Blood Transfusion, Autologous / Q000009:adverse effects / Q000191:economics; D003365:Costs and Cost Analysis; D004906:Erythrocyte Count; D004921:Erythropoietin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006400:Hematocrit; D006801:Humans; D007902:Length of Stay; D008297:Male; D016134:Organizational Policy; D011446:Prospective Studies; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D004921:Erythropoietin