title: Effects of epoetin alfa on blood transfusions and postoperative recovery in orthopaedic surgery: the European Epoetin Alfa Surgery Trial (EEST).
abstract: OBJECTIVE
  Preoperative epoetin alfa administration decreases transfusion requirements and may reduce transfusion complications, such as postoperative infection due to immune suppression and thus hospitalization time. This study examined the impact of preoperative epoetin alfa administration on postoperative recovery and infection rate.
  
  
  METHODS
  In an open randomized controlled multicentre trial in patients undergoing orthopaedic surgery, the effects of preoperative administration of epoetin alfa vs. routine care were compared in six countries. Haemoglobin (Hb) values, transfusions, time to ambulation, time to discharge, infections and safety were evaluated in patients with preoperative Hb concentrations 10-13g dL(-1) (on-treatment population: epoetin n = 460; control n = 235), from study entry until 4-6 weeks after surgery. Outcome was also compared in patients with and without transfusion.
  
  
  RESULTS
  Epoetin-treated patients had higher Hb values from the day of surgery until discharge (P < 0.001) and lower transfusion rates (12% vs. 46%; P < 0.001). Epoetin treatment delivered no significant effect on postoperative recovery (time to ambulation, time to discharge and infection rate). However, the time to ambulation (3.8+/-4.0 vs. 3.1+/-2.2days; P < 0.001)and the time to discharge (12.9+/-6.4 vs. 10.2+/-5.0 days; P < 0.001) was longer in the transfused than in the non-transfused patients. Side-effects in both groups were comparable.
  
  
  CONCLUSIONS
  Epoetin alfa increases perioperative Hb concentration in mild-to-moderately anaemic patients and thus reduces transfusion requirements. Patients receiving blood transfusions require a longer hospitalization than non-transfused patients.
authors.affiliation: Sint Maartenskliniek, Nijmegen, France.
authors.forename: E W G
authors.initials: EW
authors.lastname: Weber
authors.forename: R
authors.initials: R
authors.lastname: Slappendel
authors.forename: Y
authors.initials: Y
authors.lastname: Hémon
authors.forename: S
authors.initials: S
authors.lastname: Mähler
authors.forename: T
authors.initials: T
authors.lastname: Dalén
authors.forename: E
authors.initials: E
authors.lastname: Rouwet
authors.forename: J
authors.initials: J
authors.lastname: van Os
authors.forename: A
authors.initials: A
authors.lastname: Vosmaer
authors.forename: P
authors.initials: P
authors.lastname: van der Ark
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001803:Blood Transfusion; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects / Q000627:therapeutic use*; D005060:Europe; D005260:Female; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011994:Recombinant Proteins; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa