title: Minimizing Blood Transfusion in Total Hip and Knee Arthroplasty Through a Multimodal Approach.
abstract: BACKGROUND
  We introduced a multimodal, multidisciplinary approach to perioperative blood management aimed at reducing blood transfusions in primary knee (TKA) and hip (THA) arthroplasty. The protocol included (1) preoperative hemoglobin optimization through a multidisciplinary approach, (2) minimization of perioperative blood loss, and (3) adherence to evidence-based transfusion guidelines.
  
  
  METHODS
  Evaluation of 1010 consecutive patients undergoing primary TKA (488) or THA (522) was performed.
  
  
  RESULTS
  A significant reduction in the overall transfusion rate (1.4% vs 17.9%, P<.0001) resulted after algorithm introduction, when compared with the 1814 previous patients. Zero (0%) TKA and 4 (0.8%) THA patients adherent to protocol, and 4/488 (0.8%) TKA and 10/522 (1.9%) THA patients overall received transfusions.
  
  
  CONCLUSIONS
  Adoption of a multimodal blood management algorithm can significantly reduce blood transfusions in primary joint arthroplasty.
authors.affiliation: University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Holt
authors.affiliation: University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Miller
authors.affiliation: University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
authors.affiliation: University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Clark
authors.affiliation: University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa.
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Willenborg
authors.affiliation: University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa.
authors.forename: Nicolas O
authors.initials: NO
authors.lastname: Noiseux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000740:Anemia / Q000175:diagnosis / Q000628:therapy; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002985:Clinical Protocols; D019468:Disease Management; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D014148:Tranexamic Acid / Q000008:administration & dosage
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid
keywords: adult reconstruction; blood transfusion; total hip arthroplasty; total knee arthroplasty; tranexamic acid