title: Erythropoietin is an effective clinical modality for reducing RBC transfusion in joint surgery.
abstract: OBJECTIVE
  Efficacy trials of preoperative erythropoietin therapy (PET) recommend a dosing schedule that cannot always be adhered to in everyday clinical practice. Consequently, we instituted a flexible dosing schedule and routinely offered it to anemic patients [hemoglobin (Hb)] < or = 130 g x L(-1)) undergoing total joint arthroplasty (TJA). The purpose of this observational, cohort study was to assess the effectiveness of this practice in reducing red blood cell (RBC) transfusion.
  
  
  METHODS
  After obtaining Institutional Ethics Board approval, data were collected prospectively on all patients who underwent TJA at our institution from July 1999 to June 2003. Patients with baseline Hb < or = 130 g x L(-1) were offered PET as follows: one to three sc injections (20,000 IU for those < or = 70 kg, and 40,000 IU for those > 70 kg) every three to seven days before surgery. Since treatment was not randomly assigned, multivariable logistic regression analysis and propensity score case-control matching were used to adjust for baseline differences in patient demographics and perioperative risk factors for RBC transfusion. The adjusted relationship between PET and RBC transfusion was then determined.
  
  
  RESULTS
  Of the 1,782 patients that underwent TJA during the study period, 770 (47.9%) had a Hb < 130 g x L(-1). Of these patients, 214 received PET and their RBC transfusion rate was 16.4%, whereas the transfusion rate was 56.1% in those who did not receive PET (P < 0.0001). The adjusted odds ratio of RBC transfusion with PET was 0.33 (95% confidence interval = 0.21-0.49).
  
  
  CONCLUSIONS
  PET, used as part of routine clinical practice, is an effective blood conservation modality.
authors.affiliation: Department of Anesthesia, Unversity Health Network, University of Toronto, Ontario, Canada. keyvan.karkouti@uhn.on.ca
authors.forename: Keyvan
authors.initials: K
authors.lastname: Karkouti
authors.forename: Stuart A
authors.initials: SA
authors.lastname: McCluskey
authors.forename: Lucia
authors.initials: L
authors.lastname: Evans
authors.forename: Nizar
authors.initials: N
authors.lastname: Mahomed
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ghannam
authors.forename: Roderrick
authors.initials: R
authors.lastname: Davey
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin