title: Impact of a blood management protocol on transfusion rates and outcomes following total hip and knee arthroplasty.
abstract: Introduction Preoperative anaemia remains undertreated in the UK despite advice from national agencies to implement blood conservation measures. A local retrospective audit of 717 primary hip/knee replacements in 2008-2009 revealed 25% of patients were anaemic preoperatively. These patients experienced significantly increased transfusion requirements and length of stay. We report the results of a simple and pragmatic blood management protocol in a district general hospital. Methods Since 2010 patients at our institution who are found to be anaemic when listed for hip/knee replacement have been offered iron supplementation and/or erythropoietin depending on haemoglobin and ferritin levels. In this study, postoperative blood transfusions, length of stay and readmissions were assessed retrospectively for all patients undergoing elective primary hip/knee replacement in 2014 and compared with the baseline findings. Results During the 12-month study period, 406 patients were eligible for inclusion and none were excluded. Eighty-nine patients (22%) were anaemic preoperatively and sixty-five received treatment. The transfusion rate fell from the baseline levels of 23.0% and 6.7% to 4.3% and 0.5% for hip and knee replacements respectively (p<0.001). The median length of stay reduced from 6 to 3 days (p<0.001) for both hip and knee replacements. The rate for readmissions within 90 days fell from 13.5% to 8.9% (p<0.05). Conclusions Preoperative anaemia is common in patients listed for hip/knee replacement and it is associated strongly with increased blood transfusion. The introduction of a blood management protocol has led to significant reductions in transfusion and length of stay, sustained over a four-year period. This suggests that improved patient outcomes, conservation of blood stocks and cost savings can be achieved.
authors.affiliation: Airedale NHS Foundation Trust , UK.
authors.forename: N
authors.initials: N
authors.lastname: Frew
authors.affiliation: Airedale NHS Foundation Trust , UK.
authors.forename: D
authors.initials: D
authors.lastname: Alexander
authors.affiliation: Airedale NHS Foundation Trust , UK.
authors.forename: J
authors.initials: J
authors.lastname: Hood
authors.affiliation: Airedale NHS Foundation Trust , UK.
authors.forename: A
authors.initials: A
authors.lastname: Acornley
mesh_terms: D000740:Anemia / Q000188:drug therapy*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D000068817:Epoetin Alfa / Q000627:therapeutic use; D005290:Ferric Compounds / Q000627:therapeutic use; D005293:Ferritins / Q000097:blood; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008320:Maltose / Q000031:analogs & derivatives / Q000627:therapeutic use; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D012189:Retrospective Studies; D006113:United Kingdom
chemical_list: D005290:Ferric Compounds; D006397:Hematinics; D006454:Hemoglobins; D000068817:Epoetin Alfa; C522335:ferric carboxymaltose; D008320:Maltose; D005293:Ferritins
keywords: Anaemia; Blood transfusion; Erythropoietin; Total hip replacement; Total knee replacement