Assessment of the introduction of a blood management program in orthopaedic surgery

Objective: To assess the impact of implementing a Patient Blood management program (PBM) on transfusion rates, hospital stay, and complications for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Material and methods: A retrospective, observational study was conducted in Araba University Hospital from 2006 to 2011. All THA and TKA were included. The percentage of patients transfused with allogeneic blood was the primary endpoint. The mean of transfused blood bags, overall transfusion, complications (both overall and specific), patient age and sex, pre-operative and discharge hemoglobin, and hospital stay were recorded. Results: A total of 825 THA and 875 TKA were included. Both THA (47.6% in 2006 and 30.6% in 2011; P=.013) and TKA (33.6% in 2006 and 16.2% in 2011; P < .001) showed a significant decrease of allogeneic transfusion. The overall transfusion rate was also reduced in THA (65.7% in 2006 and 39.5% in 2011; P < .001) and TKA (38.3% in 2006 and 17.2% in 2011; P < .001). Hospital stay was reduced in both types of surgeries (P < .038 in THA and P < .0001 in TKA). In 2006 it was 9.2 +/- 2.9 days for THA and 11.1 +/- 4.7 days for TKA, whereas in 2011 it was 8.7 +/- 4.2 and 9.5 +/- 3.4 days for THA and TKA, respectively. Conclusions: Our patient blood management has decreased the percentage of patients that need both allogeneic and autologous transfusion in a statistically significant way. Although the mean hospital stay decreased, the impact of the PBM cannot be established. (C) 2014 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.