title: Patient blood management in orthopaedic surgery: a four-year follow-up of transfusion requirements and blood loss from 2008 to 2011 at the Balgrist University Hospital in Zurich, Switzerland.
abstract: BACKGROUND
  The aim of this study was to investigate the impact of the introduction of a Patient Blood Management (PBM) programme in elective orthopaedic surgery on immediate pre-operative anaemia, red blood cell (RBC) mass loss, and transfusion.
  
  
  METHODS
  Orthopaedic operations (hip, n=3,062; knee, n=2,953; and spine, n=2,856) performed between 2008 and 2011 were analysed. Period 1 (2008), was before the introduction of the PBM programme and period 2 (2009 to 2011) the time after its introduction. Immediate pre-operative anaemia, RBC mass loss, and transfusion rates in the two periods were compared.
  
  
  RESULTS
  In hip surgery, the percentage of patients with immediate pre-operative anaemia decreased from 17.6% to 12.9% (p<0.001) and RBC mass loss was unchanged, being 626±434 vs 635±450 mL (p=0.974). Transfusion rate was significantly reduced from 21.8% to 15.7% (p<0.001). The number of RBC units transfused remained unchanged (p=0.761). In knee surgery the prevalence of immediate pre-operative anaemia decreased from 15.5% to 7.8% (p<0.001) and RBC mass loss reduced from 573±355 to 476±365 mL (p<0.001). The transfusion rate dropped from 19.3% to 4.9% (p<0.001). RBC transfusions decreased from 0.53±1.27 to 0.16±0.90 units (p<0.001). In spine surgery the prevalence of immediate pre-operative anaemia remained unchanged (p=0.113), RBC mass loss dropped from 551±421 to 404±337 mL (p<0.001), the transfusion rate was reduced from 18.6 to 8.6% (p<0.001) and RBC transfusions decreased from 0.66±1.80 to 0.22±0.89 units (p=0.008).
  
  
  CONCLUSIONS
  Detection and treatment of pre-operative anaemia, meticulous surgical technique, optimal surgical blood-saving techniques, and standardised transfusion triggers in the context of PBM programme resulted in a lower incidence of immediate pre-operative anaemia, reduction in RBC mass loss, and a lower transfusion rate.
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zurich, Balgrist Hospital, Zurich, Switzerland.
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Theusinger
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zurich, Balgrist Hospital, Zurich, Switzerland.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Kind
authors.affiliation: Division of Biostatistics, Institute of Social and Preventive Medicine, University of Zurich, Balgrist Hospital, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist Hospital, Zurich, Switzerland.
authors.forename: Lain
authors.initials: L
authors.lastname: Borgeat
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist Hospital, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
authors.affiliation: Institute of Anaesthesiology, University and University Hospital Zurich, Balgrist Hospital, Zurich, Switzerland.
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000628:therapy; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D012189:Retrospective Studies; D013557:Switzerland