Patient blood management strategies in total hip and knee arthroplasty

Background: Patient blood management in total hip and knee arthroplasty involves a three-pillar approach of optimizing red blood cell mass, minimizing blood loss, and managing anemia. We describe the effect of implementation of various strategies over a 7-year period. Methods: We prospectively collected blood transfusion data over a yearly quarter in the years of 2009, 2012, 2014, and 2015 with patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), primary and revision procedures. Evidence-based patient blood management strategies were introduced, including a tranexamic acid (TXA) protocol. The data were retrospectively analyzed, with observations of rates and appropriateness of blood transfusions in the context of changes in Australian National Blood Authority guidelines. Results: There was a significant reduction in transfusion rates from 2009 to 2015 in both THA (38.5%, 24.4%, 8.5%, and 12.5% for 2009, 2012, 2014, and 2015, chi(2)= 17.9, P<0.05), and TKA (12.4%, 6.1%, 7.8%, and 2.1% for 2009, 2012, 2014, and 2015, chi(2)= 4.2, P<0.05). This coincided with an increased adherence to national blood management guidelines in both THA and TKA (chi(2)= 7.19, P=0.027). Conclusions: Patient blood management is multifaceted, and significant reductions in transfusion can be achieved in adherence to perioperative patient blood management guidelines. Tranexamic acid also is an important contributor in the improvement of transfusion rates in THA and TKA.