title: Frequent use of blood-saving measures in elective orthopaedic surgery: a 2012 Dutch blood management survey.
abstract: BACKGROUND
  Blood loss in hip and knee arthroplasties may necessitate allogeneic blood transfusions. Different blood-saving measures (BSMs) were introduced to reduce these transfusions. Purpose of the present study was to assess the frequency of BSM use, stratified by type and hospital setting of orthopaedic departments in the Netherlands.
  
  
  METHODS
  An internet-based questionnaire was sent to all heads of orthopaedic departments of Dutch hospitals and private clinics (n = 99). Questions were asked on how often BSMs were used, reported on a 5-point Likert scale (never, almost never, regularly, almost always, always). In addition there were questions about discontinuation of anticoagulants preoperatively, the number of annually performed arthroplasties (size) and hospital setting.
  
  
  RESULTS
  The survey was completed by 81 (82%) departments. BSMs used frequently (regularly, almost always, always) were erythropoietine (EPO), with 55 (68%) departments being frequent users; acute normovolemic hemodilution, used frequently in 26 (32%) departments; cell saver in 25 (31%) and postoperative drainage and re-infusion in 56 (69%) departments. When compared by size, frequent EPO use was more common in large departments (with 22 (88%) large departments being frequent users versus 13 (63%) small departments and 16 (55%) intermediate departments, p = 0.03). No differences by size or type were observed for other BSMs.
  
  
  CONCLUSIONS
  Compared with previous survey's there is a tremendous increase in use of BSMs. EPO and autologous blood salvage techniques are the most often used modalities. Costs might be saved if use of non-cost-effective BSMs is stopped.
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333, ZA the Netherlands.
authors.forename: Veronique M A
authors.initials: VM
authors.lastname: Voorn
authors.forename: Perla J
authors.initials: PJ
authors.lastname: Marang-van de Mheen
authors.forename: Manon M
authors.initials: MM
authors.lastname: Wentink
authors.forename: Cynthia
authors.initials: C
authors.lastname: So-Osman
authors.forename: Thea P M
authors.initials: TP
authors.lastname: Vliet Vlieland
authors.forename: Ankie W M M
authors.initials: AW
authors.lastname: Koopman-van Gemert
authors.forename: Rob G H H
authors.initials: RG
authors.lastname: Nelissen
authors.forename: Leti
authors.initials: L
authors.lastname: Van Bodegom-Vos
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous / Q000379:methods* / Q000706:statistics & numerical data; D004322:Drainage; D017558:Elective Surgical Procedures; D006761:Hospitals; D006801:Humans; D020407:Internet; D009985:Orthopedics / Q000379:methods*; D010956:Plasmapheresis / Q000379:methods* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
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