Preoperative erythropoietin within a patient blood management program decreases both blood transfusion and postoperative anemia: a prospective observational study
- 18 July 2020
- journal article
- research article
- Published by Wiley in Transfusion
- Vol. 60 (8), 1732-1740
- https://doi.org/10.1111/trf.15900
Abstract
BACKGROUND In orthopedic surgery, a patient blood management program (PBM) has been proposed to reduce blood transfusion. The aim of this observational study was to assess, within a PBM, the specific efficacy of preoperative erythropoietin (EPO). STUDY DESIGN AND METHODS In a single hospital, 723 patients undergoing elective primary hip or knee arthroplasty were prospectively studied. The PBM included EPO if preoperative hemoglobin was lower than 13 g/dL, intraoperative administration of tranexamic acid, use of recommended transfusion thresholds, and postoperative infusion of iron. Blood transfusion and hemoglobin were noted until discharge. Major thromboembolic or cardiovascular events were assessed during admission and 1 month after discharge. RESULTS Transfusion was noted in 2.5% patients with EPO. Transfusion rate was higher in patient for whom EPO was not indicated (13.6% transfusion rate; odds ratio [OR], 13.7; 95% confidence interval [CI], 2.6‐66; p = 10−3) or if erythropoietin was indicated but not administrated (36.8% transfusion rate; OR, 18.2; 95% CI, 3.9‐84.5; p < 10−3). Hemoglobin was significantly higher during the postoperative period in patients with erythropoietin. At hospital discharge, 57% of patients were anemic if EPO was used compared to 88% when EPO was not indicated and 87% when EPO was indicated but not administered (p < 10−6). There were no significant differences in the odds of major complications between patients with or without EPO. CONCLUSIONS Within a PBM, preoperative treatment of anemia with EPO decreased both the rate of blood transfusion and postoperative anemia. Further studies are necessary to confirm these results.Keywords
This publication has 49 references indexed in Scilit:
- The effect of a preoperative erythropoietin protocol as part of a multifaceted blood management program in daily clinical practice (CME)Transfusion, 2012
- Liberal or Restrictive Transfusion in High-Risk Patients after Hip SurgeryNew England Journal of Medicine, 2011
- Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort studyThe Lancet, 2011
- Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac SurgeryAnesthesiology, 2011
- Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelinesBritish Journal of Anaesthesia, 2011
- The Association of Perioperative Red Blood Cell Transfusions and Decreased Long-Term Survival After Cardiac SurgeryAnesthesia & Analgesia, 2009
- Risk Associated with Preoperative Anemia in Noncardiac SurgeryAnesthesiology, 2009
- Postoperative Anemia and Quality of Life After Primary Hip Arthroplasty in Patients Over 65 Years OldAnesthesia & Analgesia, 2008
- Anemia Is Associated with Disability and Decreased Physical Performance and Muscle Strength in the ElderlyJournal of the American Geriatrics Society, 2004
- Effectiveness of perioperative recombinant human erythropoietin in elective hip replacementThe Lancet, 1993