"Patient blood management" in orthopaedic surgery

Area of Science:

• Orthopaedic Surgery
• Trauma Surgery
• Anesthesiology
• Hematology

Background:

• Orthopaedic and trauma surgeries often result in substantial blood loss and postoperative anemia.
• Allogeneic blood transfusions (ABT) are frequently required but carry clinical, economic, and logistical drawbacks.

Purpose of the Study:

• To review the effectiveness and safety of Patient Blood Management (PBM) strategies in orthopaedic and trauma surgery (OTS).
• To identify barriers and requirements for implementing PBM programs in OTS.

Main Methods:

• Review of perioperative measures within PBM programs.
• Analysis of strategies including restrictive transfusion criteria, erythropoiesis stimulation, bleeding reduction, and autologous blood transfusion.
• Examination of PBM program implementation in the context of OTS.

Main Results:

• PBM programs offer a multidisciplinary approach to minimize ABT needs.
• Key PBM components include optimizing red blood cell mass, managing coagulopathy, and employing restrictive transfusion guidelines.
• Effectiveness and safety data for PBM in OTS are reviewed, alongside practical implementation considerations.

Conclusions:

• PBM programs are crucial for reducing reliance on ABT in orthopaedic and trauma surgery.
• Successful implementation requires addressing specific barriers and establishing clear requirements within the surgical specialty.
• Optimizing patient outcomes and resource utilization is a primary goal of PBM in OTS.