Allogenic Blood Transfusion Following Total Hip Arthroplasty: Results from the Nationwide Inpatient Sample, 2000 to 2009

Saleh, Anas; Small, Travis; Pillai, Aiswarya Chandran; Schiltz, Nicholas K.; Klika, Alison K.; Barsoum, Wael K.

doi:10.2106/jbjs.m.00825

Cited by 124 publications

(126 citation statements)

References 39 publications

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“…An evaluation of allogenic blood transfusions in patients undergoing elective THA found that transfusions increased total cost for patients by $1731 ± $49 compared with patients who did not receive transfusions (P < 0.001). 15 Various approaches have been studied to reduce the use of blood transfusions to prevent transfusion-related adverse events, increase patient safety, and reduce cost. The American Association of Blood Banks (AABB) published clinical practice guidelines in 2012 evaluating transfusion thresholds in hospitalized patients.…”

Section: Introductionmentioning

confidence: 99%

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

2016

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Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesis-stimulating agents, and erythropoietin.Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery patients were evaluated, provided they reported blood transfusion outcomes. Data Synthesis: A total of 9 prospective and retrospective studies and 1 meta-analysis were identified and included. In the preoperative setting, administration of oral iron, IV iron, or ESA alone or in combination to correct underlying anemia led to significantly reduced transfusion rates. Transfusion requirements were generally less with combination therapy (ESA + oral or IV iron). In the short-term perioperative or postoperative period, use of oral or IV iron led to conflicting results, with some reporting a statistically significant reduction in blood transfusions, whereas others reported none. Conclusions: In elective orthopedic surgery, IV or oral iron with or without an ESA may provide benefit in prevention of postoperative anemia and results in blood transfusion reduction without significantly increasing the risk of adverse events. These agents should be considered at the lowest effective dose with emphasis on administration prior to planned surgery.

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Section: Introductionmentioning

confidence: 99%

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

2016

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“…LOS was longer for patients who received an allogeneic transfusion in our study, which was not influenced by adherence to the protocol. Inappropriate use of blood transfusions has been reported by others to occur 25% of the time causing an increase in LOS [9], cost [20], and patient transfer to inpatient facilities [20], not to mention other associated risks and complications of blood transfusions [3,4,10,12,14,15,18,19]. We expect that over time, by reducing transfusions in patients undergoing TJA, overall transfusionrelated complications would decrease without an increase in ischemic morbidity.…”

Section: Discussionmentioning

confidence: 90%

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative

Markel

Allen

Zappa

2016

Clinical Orthopaedics &Amp; Related Research

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Background Standardized care plans are effective at controlling cost and quality. Registries provide insights into quality and outcomes for use of implants, but most registries do not combine implant and care quality data. In 2012, several Michigan area hospitals and a major insurance provider formed a voluntary statewide total joint database/registry, the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), to collect procedural, hospital, discharge, and readmission data. Noting substantial variation in transfusion practices after total joint arthroplasty (TJA) in our institutions, we used these prospectively collected data to examine whether awareness and education of the American Association of Blood Banks' (AABB) transfusion guidelines would result in decreased transfusions. Questions/purposes (1) Can an established arthroplasty registry help implement a quality initiative (QI) designed to decrease the proportion of transfused postoperative patients undergoing TJA? (2) Do data-driven transfusion protocols decrease length of stay without increasing ischemic complications (myocardial infarctions and cerebrovascular accidents)? (3) Are decreased transfusion proportions associated with decreased readmissions, nonischemic morbidity (including deep vein thrombosis and deep prosthetic infection), and mortality in postoperative patients who had undergone TJA? Methods After reviewing data from the recently established MARCQI registry, the orthopaedic department noticed many discrepancies and practice variances regarding blood transfusions among their providers. In October 2013, a QI was implemented to raise awareness of the discrepancies and education about the AABB guidelines was presented at the monthly orthopaedic service line meeting. A total of 1872 TJA cases were reviewed; 50 were excluded for incomplete data and two for intraoperative transfusions for the period before education (May 2012 to June 2013, n = 1240) and after education (November 2013 to April 2014, n = 580). Data collected included gender, age, length of stay, body mass index, preoperative hemoglobin level, lowest postoperative hemoglobin level during admission, transfusion status, number of units transfused, ischemic and nonischemic morbidity, hospital One or more of the authors (DCM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Stryker (Kalamazoo, MI, USA), Arboretum Ventures (Ann Arbor, MI, USA), Novi Bone and Joint (Novi, MI, USA), and CORE (Southfield, MI, USA). One or more of the authors (DCM) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Stryker and the Orthopaedic Research and Education Foundation (Rosemont, IL, USA) in the amount of USD 100,001 to USD 1,000,000. All ICMJE Conflict of Interest Forms for authors a...

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“…Their study also directly assessed costs and found an increased total cost of $1777 per admission for patients who received a transfusion. Saleh et al [29] found an increased LOS of 0.58 days and an increased total cost of $1731 per admission when patients received a transfusion after primary THA. Both TXA and transfusion have direct costs associated with them, but they may also affect overall costs through their relationships with LOS.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid Benefits Total Joint Arthroplasty Patients Regardless of Preoperative Hemoglobin Value

Whiting

Duncan

Sierra

et al. 2015

The Journal of Arthroplasty

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While tranexamic acid (TXA) reduces transfusion in total joint arthroplasty (TJA), it remains unclear whether there is a preoperative hemoglobin (Hgb) threshold above which it is no longer beneficial. 2100 primary TJA patients were retrospectively categorized by preoperative Hgb; 1161 (55%) received TXA. Transfusion rates decreased with TXA in all groups; with Hgb>15 the transfusion rate was 0.5% with TXA and 4.5% without (P=0.0086); with Hgb>11 the transfusion rate was 4.7% with TXA and 18.7% without (P<0.0001). Patients receiving TXA had a shorter LOS by 0.51 days (P<0.0001). Patients receiving a postoperative transfusion had a longer LOS by 0.69 days (P<0.0001). TXA should be considered in all TJA patients independent of preoperative Hgb level.

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Allogenic Blood Transfusion Following Total Hip Arthroplasty: Results from the Nationwide Inpatient Sample, 2000 to 2009

Cited by 124 publications

References 39 publications

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative

Tranexamic Acid Benefits Total Joint Arthroplasty Patients Regardless of Preoperative Hemoglobin Value

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