Blood management programs may decrease need for transfusions in orthopedic patients, study shows

Written by Jackie Drees | August 21, 2018 | Print  | Email

Reducing the amount of transfused blood that orthopedic patients undergoing surgeries receive may improve patient outcomes while also decreasing costs, according to a study published in Anesthesiology.

The study's lead author, Steven M. Frank, MD, who is also the director of Baltimore-based Johns Hopkins Health System's blood management program, said while there's a strong impression orthopedic surgery patients need a higher hemoglobin transfusion threshold, risks are reduced when that threshold is decreased.

Prior to the study, the American Association of Blood Banks' guidelines indicated orthopedic patients needed blood transfusions when hemoglobin levels drop to 8 grams per deciliter. For most patients, the guideline is to administer blood transfusions when hemoglobin levels hit 7 g/dL.

Researchers used the blood management program to evaluate transfusion outcomes in all adult orthopedic patients over a four-year period, including before the program began. The goal was to determine if orthopedic patients would benefit from receiving blood transfusions when hemoglobin level dropped to 7 g/dL instead of 8 g/dL. The study included 1,507 patients before the program's implementation and 2,402 post-implementation.

The blood management program comprised 10 strategies, including only administering a single unite of blood unless the patient was actively hemorrhaging and maintaining normal body temperature during surgery to reduce bleeding.

The percentage of orthopedic surgery patients who received blood transfusions fell from 16.1 percent to 9.4 percent after the blood management program was introduced, and overall blood use during transfusions decreased by 32.5 percent. Additionally, 30-day readmissions shrank from 9 percent to 5.8 percent, and surgeons saw improved outcomes in patients over 65 years old.

Despite the study's suggestion that most orthopedic patients could be transfused at a hemoglobin level of 7 g/dL instead of 8 g/dL, more research needs to be done to indicate if a change is necessary, safe and beneficial to the patient.

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