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Ten-year follow-up on Dutch orthopaedic blood management (DATA III survey)
M C Struijk-Mulder1, W G Horstmann, C C Verheyen
1Department of Orthopaedic Surgery and Traumatology, Isala Clinics, Postbus 10400, 8000 GK, Zwolle, The Netherlands, mcstruijk@gmail.com.
Insights
Dutch hospitals continue to widely use erythropoietin and postoperative autologous retransfusion for hip and knee replacements. However, effective blood management strategies like tranexamic acid remain underutilized.
Area of Science:
- Orthopaedic Surgery
- Transfusion Medicine
- Patient Blood Management
Background:
- Allogeneic blood transfusions frequently complicate hip and knee arthroplasties.
- Assessing current perioperative blood-saving measures is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the contemporary use of perioperative blood-saving techniques in Dutch orthopaedic departments.
- To compare current practices with data from 5 and 10 years prior.
Main Methods:
- A follow-up survey was distributed to all Dutch hospital orthopaedic surgery departments.
- Data collected were compared to previous survey results from 2007 and 2012.
Main Results:
- Erythropoietin use is common, often replacing preoperative autologous blood donation.
- Intraoperative autologous retransfusion rates remain largely unchanged for revision arthroplasty.
- Postoperative autologous retransfusion is utilized by most departments for primary and revision hip/knee arthroplasty.
Conclusions:
- Erythropoietin, normothermia, and postoperative autologous retransfusion are standard in Dutch orthopaedic departments for hip and knee arthroplasty.
- Intraoperative retransfusion is primarily employed in hip revision arthroplasty.
- Effective blood management strategies, such as tranexamic acid, are not widely adopted.
Introduction:
Hip and knee arthroplasties are frequently complicated by the need for allogeneic blood transfusions. This survey was conducted to assess the current use of perioperative blood-saving measures and to compare it with prior results.
Materials And Methods:
All departments of orthopaedic surgery at Dutch hospitals were sent a follow-up survey on perioperative blood-saving measures, and data were compared to the results of two surveys conducted 5 and 10 years earlier.
Results:
The response rate was 94 out of 108 departments (87%). Most departments used erythropoietin prior to hip and knee replacements at the expense of preoperative autologous blood donation. The use of intraoperative autologous retransfusion in revision hip (56 vs. 54%) as well as revision knee arthroplasty (26 vs. 24%), was virtually unchanged. Postoperative autologous retransfusion is still used by the majority of departments after both primary arthroplasty and revision of hip (58/53%) and knee (65/61%).
Conclusions:
Currently, just as in 2007, the majority of Dutch orthopaedic departments uses erythropoietin, normothermia and postoperative autologous retransfusion with hip and knee arthroplasty. Intraoperative retransfusion is used mainly with hip revision arthroplasty. Other effective blood management modalities such as tranexamic acid have not been widely implemented.
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