Minimizing Blood Transfusion in Total Hip and Knee Arthroplasty Through a Multimodal Approach
Joshua B Holt1, Benjamin J Miller1, John J Callaghan1
1University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, Iowa.
Background:
We introduced a multimodal, multidisciplinary approach to perioperative blood management aimed at reducing blood transfusions in primary knee (TKA) and hip (THA) arthroplasty. The protocol included (1) preoperative hemoglobin optimization through a multidisciplinary approach, (2) minimization of perioperative blood loss, and (3) adherence to evidence-based transfusion guidelines.
Methods:
Evaluation of 1010 consecutive patients undergoing primary TKA (488) or THA (522) was performed.
Results:
A significant reduction in the overall transfusion rate (1.4% vs 17.9%, P<.0001) resulted after algorithm introduction, when compared with the 1814 previous patients. Zero (0%) TKA and 4 (0.8%) THA patients adherent to protocol, and 4/488 (0.8%) TKA and 10/522 (1.9%) THA patients overall received transfusions.
Conclusion:
Adoption of a multimodal blood management algorithm can significantly reduce blood transfusions in primary joint arthroplasty.
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