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    Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle

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    Publication date
    2012
    Author
    Kotze, A.
    Carter, L. A.
    Scally, Andy J.
    Keyword
    Aged
    Aged, 80 and over
    Algorithms
    Anemia therapy
    Arthroplasty, Replacement, Hip
    Arthroplasty, Replacement, Knee
    Blood Transfusion
    Female
    Hemoglobins/analysis
    Humans
    Length of Stay
    Male
    Patient Readmission
    Preoperative Care
    Quality Improvement
    Retrospective Studies
    Treatment Outcome
    REF 2014
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    Abstract
    BACKGROUND: There are few data on the associations between anaemia, allogeneic blood transfusion (ABT), patient blood management, and outcome after arthroplasty in the UK. National agencies nevertheless instruct NHS Trusts to implement blood conservation measures including preoperative anaemia management. Internationally, blood management programmes show encouraging results. METHODS: We retrospectively audited 717 primary hip or knee arthroplasties in a UK general hospital and conducted regression analyses to identify outcome predictors. We used these data to modify previously published algorithms for UK practice and audited its introduction prospectively. The retrospective audit group served as a control. RESULTS: Preoperative haemoglobin (Hb) concentration predicted ABT (odds ratio 0.25 per 1 g dl(-1), P<0.001). It also predicted the length of stay (LOS, effect size -0.7 days per 1 g dl(-1), P=0.004) independently of ABT, including in non-anaemic patients. Patient blood management implementation was associated with lower ABT rates for hip (23-7%, P<0.001) and knee (7-0%, P=0.001) arthroplasty. LOS for total hip replacement and total knee replacement decreased from 6 (5-8) days to 5 (3-7) and 4 (3-6) days, respectively, after algorithm implementation (P<0.001). The all-cause re-admission rate within 90 days decreased from 13.5% (97/717) before to 8.2% (23/281) after algorithm implementation (P=0.02). CONCLUSIONS: We conclude that preoperative Hb predicts markers of arthroplasty outcome in UK practice. A systematic approach to optimize Hb mass before arthroplasty and limit Hb loss perioperatively was associated with improved outcome up to 90 days after discharge.
    URI
    http://hdl.handle.net/10454/6057
    Citation
    Kotze, A., Carter, L. A., Scally, A. J. (2012) Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle. Br J Anaesth, 108 (6), 943-52.
    Link to publisher’s version
    http://dx.doi.org/10.1093/bja/aes135
    Type
    Article
    Collections
    Health Studies Publications

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