Preoperative erythropoietin within a patient blood management program decreases both blood transfusion and postoperative anemia: a prospective observational study

Biboulet, Philippe; Motais, Caroline; Pencole, Mathieu; Karam, Oliver; Dangelser, Gaétan; Smilevitch, Pierre; Maissiat, Guillaume; Capdevila, Xavier; Bringuier, Sophie

doi:10.1111/trf.15900

Cited by 9 publications

(6 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Females tended to have lower Hb levels before surgery; Steuber et al identified females accounting for 92% of patients with pre-operative iron deficiency anemia ( 18 ). Biboulet et.al found blood transfusion was more common in females through univariate analysis, though such significance disappeared in multivariate analysis ( 19 ). Another group of researchers obtained similar results that female patients were more likely to receive transfusion than males ( 20 ); thus, it’s reasonable that we included sex as one of the predictors in our nomogram.…”

Section: Discussionmentioning

confidence: 99%

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

2022

View full text Add to dashboard Cite

IntroductionThe loss of blood is a significant problem in Total Knee Arthroplasty (TKA). Anemia often occurs after such surgeries, leading to serious consequences, such as higher postoperative infection rates and longer hospital stays. Tools for predicting possible anemia can provide additional guidance in realizing better blood management of patients.Methods2,165 patients who underwent TKA from 2015 to 2019 in the same medical center were divided into training and validation cohorts. Both univariate and multivariate logistic regression analyses were performed to identify independent preoperative risk factors for anemia. Based on these predictors, a nomogram was established using the area under the curve (AUC), calibration curve (AUC), and the area under the curve (AUC). The model was then applied to the validation cohort, and decision curve analyses (DCA) were also plotted.ResultsThrough analysis of both univariate and multivariate logistic regression, five independent predictors were found in the training cohort: female, relatively low BMI, low levels of preoperative hemoglobin, abnormally high levels of ESR, and simultaneously two sides of TKA in the same surgery. The AUCs of the nomogram were 74.6% (95% CI, 71.35%–77.89%) and 68.8% (95% CI, 63.37%–74.14%) of training and the validation cohorts separately. Furthermore, the calibration curves of both cohorts illustrated the consistency of the nomogram with the actual condition of anemia of patients after TKA. The DCA curve was higher for both treat-none and treat-all, further indicating the relatively high practicality of the model.ConclusionFemale, lower BMI, lower levels of preoperative Hb, simultaneous bilateral TKA, and high levels of preoperative ESR were figured out as five independent risk factors for postoperative anemia (<9.0 g/dL) in patients undergoing TKA. Based on the findings, a practical nomogram was constructed to predict risk of postoperative anemia. The evidence level should be level 4 according to guideline.

show abstract

Section: Discussionmentioning

confidence: 99%

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

2022

View full text Add to dashboard Cite

show abstract

“…1026 Additionally, an observational study of 723 patients undergoing elective primary hip or knee arthroplasty noted that inclusion of pre-operative EPO in the PBM programme (if pre-operative Hb <13 g dl À1 ) reduced the rate of blood transfusion and postoperative anaemia. 1027 Based on these and similar data, the international consensus statement on management of postoperative anaemia suggests considering the use of ESAs in noncancer patients with severe postoperative anaemia and inflammation-induced blunted erythropoiesis those declining blood transfusion. 1005 Current guidelines for PBM recommend a restrictive transfusion strategy for RBCs without specifying explicit Hb thresholds for the postoperative phase, but generally emphasising physiological RBC transfusion triggers (taking into consideration the patient's signs of organ ischaemia and the influence of pre-existing cardiovascular disease on the adequacy of cardiopulmonary reserve and tolerance to anaemia).…”

Section: Evidence Summarymentioning

confidence: 97%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

147

View full text Add to dashboard Cite

BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

show abstract

“…Identifying a robust preoperative HB cutoff could offer opportunities for doctors to treatment patient’s anemia and decrease the PMSA risk. Patients whose preoperative HB was less than the cutoff value could receive intervention early, such as erythropoietin and iron supplementation, to avoid PMSA and associated complications [ 22 – 27 ].…”

Section: Discussionmentioning

confidence: 99%

Association between preoperative hemoglobin and postoperative moderate and severe anemia among patients undergoing primary total knee arthroplasty: a single-center retrospective study

Cao

Yang

et al. 2021

J Orthop Surg Res

View full text Add to dashboard Cite

Background Postoperative moderate and severe anemia (PMSA) has been a serious perioperative complication in primary total knee arthroplasty (TKA). However, the ideal cutoff values to predict PMSA is still undetermined. The aim of this study was (1) to identify the risk factors associated with PMSA and (2) to establish the cutoff values of preoperative hemoglobin (HB) associated with increased PMSA in primary TKA. Methods We identified 474 patients undergoing primary TKA and separated those in which PMSA (HB was less than 110 g/L on postoperative day 1 and 3) was developed from those without PMSA. Multivariate logistic regression model was used to identify independent risk factors for PMSA. Area under the receiver-operator curve (AUC) was used to determine the best-supported preoperative HB cutoff across all the patients. Results The PMSA rate in primary TKA was 53.2%. Significant risk factors were lower preoperative HB (OR [odds ratio] = 1.138, 95% CI [confidence interval] = 1.107–1.170, p < 0.001) and more intraoperative blood loss (OR = 1.022, 95% CI 1.484–4.598, p < 0.001). A preoperative HB cutoff value that maximized the AUC was 138.5 g/L for men (sensitivity: 79.4%, specificity: 75.0%) and 131.5 g/L for women (sensitivity: 74.7%, specificity: 80.5%), respectively. Conclusion We should recognize and consider the related risk factors to establish specific, personalized risk assessment for PMSA, including preoperative HB and intraoperative blood loss. Of these, preoperative HB was a referable tool to predict PMSA in primary TKA.

show abstract

Preoperative erythropoietin within a patient blood management program decreases both blood transfusion and postoperative anemia: a prospective observational study

Cited by 9 publications

References 47 publications

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Association between preoperative hemoglobin and postoperative moderate and severe anemia among patients undergoing primary total knee arthroplasty: a single-center retrospective study

Contact Info

Product

Resources

About