title: The effect of a preoperative erythropoietin protocol as part of a multifaceted blood management program in daily clinical practice (CME).
abstract: BACKGROUND
  The effectiveness of a preoperative erythropoietin (EPO) protocol to reduce allogeneic blood transfusions (ABTs) in daily clinical practice has been insufficiently studied. This study evaluated the effect of such a protocol, as part of a multifaceted blood management program, in patients undergoing total hip arthroplasty (THA).
  
  
  METHODS
  This retrospective observational study was designed as an interrupted time series (1999-2010). The intervention was the introduction of an EPO protocol in THA patients in 2003. Patients were classified according to preoperative hemoglobin (Hb) level: 10 to 13 g/dL (eligible patients for EPO) and more than 13 g/dL. The primary outcome was the percentage of patients receiving an ABT. Segmented regression analysis was used to estimate changes in outcome after the intervention.
  
  
  RESULTS
  A total of 4568 THA patients were included. The absolute reductions in ABTs after the intervention were 17% (95% confidence interval [CI], 6%-29%) for the total study population and 25% (95% CI, 11%-39%) and 8% (95% CI, -5% to 21%) for the Hb groups 10 to 13 and more than 13 g/dL, respectively. In the postintervention period, 46% of the eligible patients (Hb level, 10-13 g/dL) actually received EPO. The transfusion rate in the EPO group was lower compared to the non-EPO group: 14 and 50%, respectively (p < 0.01).
  
  
  CONCLUSIONS
  Introduction of a preoperative EPO protocol reduced the transfusion rate in THA patients in daily clinical practice. The reduction must be seen as part of a multifaceted blood management program, in which increased awareness of blood transfusion contributes simultaneously and substantially to the reduction in transfusion rate.
authors.affiliation: Department of Clinical Pharmacy, Department of Anesthesiology, Medical Center Alkmaar, Alkmaar, the Netherlands; Department of Clinical Pharmacy, Department of Clinical Chemistry and Haematology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center; Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands.
authors.forename: Hieronymus J
authors.initials: HJ
authors.lastname: Doodeman
authors.forename: Ingrid M M
authors.initials: IM
authors.lastname: van Haelst
authors.forename: Toine C G
authors.initials: TC
authors.lastname: Egberts
authors.forename: Martin
authors.initials: M
authors.lastname: Bennis
authors.forename: Han S
authors.initials: HS
authors.lastname: Traast
authors.forename: Wouter W
authors.initials: WW
authors.lastname: van Solinge
authors.forename: Cor J
authors.initials: CJ
authors.lastname: Kalkman
authors.forename: Wilton A
authors.initials: WA
authors.lastname: van Klei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D001803:Blood Transfusion / Q000379:methods*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D004921:Erythropoietin