title: Perioperative blood management programme reduces the use of allogenic blood transfusion in patients undergoing total hip and knee arthroplasty.
abstract: BACKGROUND
  Optimisation of blood management in total hip (THA) and knee arthroplasty (TKA) is associated with improved patient outcomes. This study aimed to establish the effectiveness of a perioperative blood management programme in improving postoperative haemoglobin (Hb) and reducing the rate of allogenic blood transfusion.
  
  
  METHODS
  This retrospective before and after study involves 200 consecutive patients undergoing elective TKA and THA before (Usual Care group) and after (Intervention group) the introduction of a blood management programme in an Australian teaching hospital. Patients in the Intervention group underwent preoperative treatment for anaemia and received intraoperative tranexamic acid (15 mg/kg). The primary outcomes were to compare postoperative Hb levels and the rate of blood transfusion. Secondary outcomes included measurements of total amount of allogenic blood transfused, transfusion-related complications, postoperative complications, need for inpatient rehabilitation and duration of hospital stay.
  
  
  RESULTS
  There were no differences between baseline characteristics between groups. The mean (SD) preoperative Hb was higher in the Intervention group compared to that in the Usual Care group: 138.7 (13.9) vs. 133.4 (13.9) g/L, p = 0.008, respectively. The postoperative day 1 Hb, lowest postoperative Hb and discharge Hb were all higher in the Intervention group (p < 0.001). Blood transfusion requirements were lower in the Intervention group compared to the Usual Care group (6 vs. 20 %, p = 0.003). There were no differences in any of the secondary outcomes measured. Patients who were anaemic preoperatively and who underwent Hb optimisation had higher Hb levels postoperatively (odds ratio 5.7; 95 % CI 1.3 to 26.5; p = 0.024).
  
  
  CONCLUSIONS
  The introduction of a perioperative blood optimisation programme improved postoperative Hb levels and reduced the rate of allogenic blood transfusion.
authors.affiliation: Department of Orthopaedic Surgery, Austin Hospital, Studley Road, Victoria, 3084, Australia. paul.kopanidis@austin.org.au.
authors.forename: Paul
authors.initials: P
authors.lastname: Kopanidis
authors.affiliation: Department of Orthopaedic Surgery, Austin Hospital, Studley Road, Victoria, 3084, Australia. andrew.hardidge@austin.org.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hardidge
authors.affiliation: Department of Surgery, The University of Melbourne, Victoria, 3010, Australia. larry.mcnicol@austin.org.au.|Department of Anaesthesia, Austin Hospital, Studley Road, Victoria, 3084, Australia. larry.mcnicol@austin.org.au.
authors.forename: Larry
authors.initials: L
authors.lastname: McNicol
authors.affiliation: Department of Anaesthesia, Royal Darwin Hospital, Rocklands Drive, Tiwi, Northern Territory, 0810, Australia. stanley.tay@gmail.com.
authors.forename: Stanley
authors.initials: S
authors.lastname: Tay
authors.affiliation: Department of Anaesthesia, Austin Hospital, Studley Road, Victoria, 3084, Australia. peter.mccall@austin.org.au.
authors.forename: Peter
authors.initials: P
authors.lastname: McCall
authors.affiliation: Department of Surgery, The University of Melbourne, Victoria, 3010, Australia. laurence.weinberg@austin.org.au.|Department of Anaesthesia, Austin Hospital, Studley Road, Victoria, 3084, Australia. laurence.weinberg@austin.org.au.|Anaesthesia Perioperative Pain Medicine Unit, University of Melbourne, Victoria, 3084, Australia. laurence.weinberg@austin.org.au.
authors.forename: Laurence
authors.initials: L
authors.lastname: Weinberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000628:therapy; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D012189:Retrospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use; D065227:Transfusion Reaction; D055815:Young Adult
chemical_list: D000933:Antifibrinolytic Agents; D006454:Hemoglobins; D014148:Tranexamic Acid; D007501:Iron