Cristian Pinilla-Gracia1, Jesús Mateo-Agudo1, Antonio Herrera2,3, Manuel Muñoz4. 1. Department of Orthopaedic Surgery and Traumatology, "Miguel Servet" University Hospital, Zaragoza, Spain. 2. Department of Surgery, University of Zaragoza, Zaragoza, Spain. 3. Aragón's Health Research Institute, Zaragoza, Spain. 4. Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain.
Abstract
BACKGROUND: Preoperative anaemia is highly prevalent among patients scheduled for total hip arthroplasty (THA), and is the main risk factor for perioperative red blood cell transfusion (RBCT). This retrospective cohort study aimed at assessing whether preoperative haemoglobin (Hb) optimisation reduced RBCT rates and improved outcome in this patient population. MATERIALS AND METHODS: All patients entered a Patient Blood Management (PBM) programme consisting of in-hospital erythropoiesis stimulation, tranexamic acid administration, and a restrictive RBCT policy. Data from preoperatively anaemic patients (Hb <13 g/dL) who underwent THA, before (2015-2016, control group, n=75) or after (2017-2018, study group, n=70) the incorporation of a preoperative Hb optimisation protocol (Ferric carboxymaltose IV, 1,000 mg ± epoetin-α, 40,000 IU; administered 4 weeks prior to surgery) to the PBM programme underwent a comparative analysis. RESULTS: Haemoglobin concentrations at preoperative assessment were similar (12.1±0.7 g/dL vs 12.2±0.7 g/dL, for study and control groups, respectively; p=0.129). At hospital admission, significantly higher Hb were observed in the study group (13.4±0.8 g/dL vs 12.2±0.7 g/dL, respectively; p=0.001), with anaemia being corrected in 79% of cases. Compared to the control group, reduced perioperative RBCT rate (4% vs 24%, respectively; p=0.001), shorter length of hospital stay (6 [range 5-7] days vs 7 [5-8 days], respectively; p=0.002), and increased proportion of patients being discharged directly to their home (74% vs 47%, respectively; p=0.01) were observed in the study group. No treatment-related side-effects were witnessed. DISCUSSION: Within a PBM programme for THA, preoperative Hb optimisation was efficacious at correcting anaemia and minimising RBCT requirements, thus contributing to an improvement in postoperative outcomes.
BACKGROUND: Preoperative anaemia is highly prevalent among patients scheduled for total hip arthroplasty (THA), and is the main risk factor for perioperative red blood cell transfusion (RBCT). This retrospective cohort study aimed at assessing whether preoperative haemoglobin (Hb) optimisation reduced RBCT rates and improved outcome in this patient population. MATERIALS AND METHODS: All patients entered a Patient Blood Management (PBM) programme consisting of in-hospital erythropoiesis stimulation, tranexamic acid administration, and a restrictive RBCT policy. Data from preoperatively anaemic patients (Hb <13 g/dL) who underwent THA, before (2015-2016, control group, n=75) or after (2017-2018, study group, n=70) the incorporation of a preoperative Hb optimisation protocol (Ferric carboxymaltose IV, 1,000 mg ± epoetin-α, 40,000 IU; administered 4 weeks prior to surgery) to the PBM programme underwent a comparative analysis. RESULTS: Haemoglobin concentrations at preoperative assessment were similar (12.1±0.7 g/dL vs 12.2±0.7 g/dL, for study and control groups, respectively; p=0.129). At hospital admission, significantly higher Hb were observed in the study group (13.4±0.8 g/dL vs 12.2±0.7 g/dL, respectively; p=0.001), with anaemia being corrected in 79% of cases. Compared to the control group, reduced perioperative RBCT rate (4% vs 24%, respectively; p=0.001), shorter length of hospital stay (6 [range 5-7] days vs 7 [5-8 days], respectively; p=0.002), and increased proportion of patients being discharged directly to their home (74% vs 47%, respectively; p=0.01) were observed in the study group. No treatment-related side-effects were witnessed. DISCUSSION: Within a PBM programme for THA, preoperative Hb optimisation was efficacious at correcting anaemia and minimising RBCT requirements, thus contributing to an improvement in postoperative outcomes.
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