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Preoperative Blood Management Strategy for Elective Hip and Knee Arthroplasty.

Publication ,  Journal Article
Kurian, DJ; Guinn, NR; Hunting, J; Gamble, JF; Hopkins, TJ; Grimsley, A; Guercio, JR; Bolognesi, MP; Schroeder, R; Aronson, S
Published in: J Healthc Qual
2019

To improve quality and outcomes, a preoperative anemia clinic (PAC) was established to screen, evaluate, and manage preoperative anemia. A retrospective review of primary and revision hip and knee arthroplasty patients from August 2013 to September 2017 was conducted. Patients at "high risk" for transfusion were referred to PAC for treatment with iron, erythropoietin, or both based on anemia type. Preoperative anemia clinic referred patients were compared with a 1:3 historic propensity-matched control set of patients to help determine impact of PAC. Forty PAC patients were compared with 120 control patients. Among PAC patients, 26 (63.41%) received iron only, 3 (7.32%) received erythropoietin (EPO) only, and 12 (29.27%) received both. Preoperative hemoglobin significantly increased in the treatment group (median [interquartile range] 10.9 g/dl [10.3-11.2] vs. 12.0 g/dl [11.2-12.7]; p < .001). Four PAC patients (10.00%) received red blood cell transfusions compared with 29 (24.17%) from matched controls (p = .055). In addition, the PAC cohort had higher postoperative nadir hemoglobin levels (mean [SD] 9.7 g/dl [1.31] vs. 8.7 g/dl [1.25]; p < .001). High-risk patients appropriately treated with iron and/or EPO before surgery demonstrate a significant increase in preoperative hemoglobin, trend toward decrease perioperative transfusion, and increased hemoglobin levels postoperatively compared with matched controls.

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Published In

J Healthc Qual

DOI

EISSN

1945-1474

Publication Date

2019

Volume

41

Issue

6

Start / End Page

376 / 383

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Preoperative Care
  • Middle Aged
  • Male
  • Humans
  • Female
  • Blood Transfusion
  • Arthroplasty, Replacement, Knee
  • Arthroplasty, Replacement, Hip
  • Anemia
 

Citation

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Kurian, D. J., Guinn, N. R., Hunting, J., Gamble, J. F., Hopkins, T. J., Grimsley, A., … Aronson, S. (2019). Preoperative Blood Management Strategy for Elective Hip and Knee Arthroplasty. J Healthc Qual, 41(6), 376–383. https://doi.org/10.1097/JHQ.0000000000000207
Kurian, Dinesh J., Nicole R. Guinn, John Hunting, John F. Gamble, Thomas J. Hopkins, Aime Grimsley, Jason R. Guercio, Michael P. Bolognesi, Rebecca Schroeder, and Solomon Aronson. “Preoperative Blood Management Strategy for Elective Hip and Knee Arthroplasty.J Healthc Qual 41, no. 6 (2019): 376–83. https://doi.org/10.1097/JHQ.0000000000000207.
Kurian DJ, Guinn NR, Hunting J, Gamble JF, Hopkins TJ, Grimsley A, et al. Preoperative Blood Management Strategy for Elective Hip and Knee Arthroplasty. J Healthc Qual. 2019;41(6):376–83.
Kurian, Dinesh J., et al. “Preoperative Blood Management Strategy for Elective Hip and Knee Arthroplasty.J Healthc Qual, vol. 41, no. 6, 2019, pp. 376–83. Pubmed, doi:10.1097/JHQ.0000000000000207.
Kurian DJ, Guinn NR, Hunting J, Gamble JF, Hopkins TJ, Grimsley A, Guercio JR, Bolognesi MP, Schroeder R, Aronson S. Preoperative Blood Management Strategy for Elective Hip and Knee Arthroplasty. J Healthc Qual. 2019;41(6):376–383.
Journal cover image

Published In

J Healthc Qual

DOI

EISSN

1945-1474

Publication Date

2019

Volume

41

Issue

6

Start / End Page

376 / 383

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Preoperative Care
  • Middle Aged
  • Male
  • Humans
  • Female
  • Blood Transfusion
  • Arthroplasty, Replacement, Knee
  • Arthroplasty, Replacement, Hip
  • Anemia