title: Blood Management Strategies to Reduce Transfusions After Elective Lower-Extremity Joint Arthroplasty Surgeries: One Tertiary Care Hospital's Early Experience With an Alternative Payment Model-a Total Joint "Bundle".
abstract: Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post. Fractional logistic regression was used to describe differences between various intervention periods. During the study period, 2511 patients underwent TJA. Compared with the preintervention period, there was 81.8% decrease in total units of RBCT during the postintervention period. Using activity-based costing (~$1000/unit), the annualized saving in RBC expenditure was $480 000. A multidisciplinary approach can be successful and sustainable in reducing RBCT and its associated costs for patients undergoing TJA.
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.|2 Tufts University School of Medicine, Boston, MA.
authors.forename: Ankit
authors.initials: A
authors.lastname: Kansagra
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.|2 Tufts University School of Medicine, Boston, MA.
authors.forename: Chester
authors.initials: C
authors.lastname: Andrzejewski
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.
authors.forename: Robert
authors.initials: R
authors.lastname: Krushell
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lehman
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Greenbaum
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.
authors.forename: Paul
authors.initials: P
authors.lastname: Visintainer
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.
authors.forename: Joan
authors.initials: J
authors.lastname: McGirr
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mahoney
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.
authors.forename: Darlene
authors.initials: D
authors.lastname: Cloutier
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.
authors.forename: Alice
authors.initials: A
authors.lastname: Ehresman
authors.affiliation: 1 Baystate Medical Center, Springfield, MA.|2 Tufts University School of Medicine, Boston, MA.
authors.forename: Mihaela S
authors.initials: MS
authors.lastname: Stefan
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D017558:Elective Surgical Procedures; D017707:Erythrocyte Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles / Q000191:economics / Q000379:methods*; D058996:Quality Improvement; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: blood transfusion; health care cost; joint arthroplasty; quality improvement