Preoperative erythropoietin within a patient blood management program decreases both blood transfusion and postoperative anemia: a prospective observational study
Corresponding Author
Philippe Biboulet
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Address reprint requests to: Dr. Philippe Biboulet, MD, Département d'Anesthésie Réanimation Hôpital Lapeyronie, Centre Hospitalier et Universitaire, 34295 Montpellier Cedex 5, France; e-mail: [email protected].Search for more papers by this authorCaroline Motais
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Search for more papers by this authorMathieu Pencole
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Search for more papers by this authorOliver Karam
Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA
Search for more papers by this authorGaëtan Dangelser
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Search for more papers by this authorPierre Smilevitch
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Search for more papers by this authorGuillaume Maissiat
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Search for more papers by this authorXavier Capdevila
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Inserm Unit Neuro Sciences Institute, University of Montpellier, Montpellier, France
Search for more papers by this authorSophie Bringuier
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Department of Medical Statistics, CHU Montpellier, University of Montpellier, Montpellier, France
Search for more papers by this authorCorresponding Author
Philippe Biboulet
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Address reprint requests to: Dr. Philippe Biboulet, MD, Département d'Anesthésie Réanimation Hôpital Lapeyronie, Centre Hospitalier et Universitaire, 34295 Montpellier Cedex 5, France; e-mail: [email protected].Search for more papers by this authorCaroline Motais
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Search for more papers by this authorMathieu Pencole
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Search for more papers by this authorOliver Karam
Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia, USA
Search for more papers by this authorGaëtan Dangelser
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Search for more papers by this authorPierre Smilevitch
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Search for more papers by this authorGuillaume Maissiat
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Search for more papers by this authorXavier Capdevila
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Inserm Unit Neuro Sciences Institute, University of Montpellier, Montpellier, France
Search for more papers by this authorSophie Bringuier
Department of Anesthesiology and Critical Care Medicine, Hôpital Lapeyronie, Montpellier, France
Department of Medical Statistics, CHU Montpellier, University of Montpellier, Montpellier, France
Search for more papers by this authorSupport was provided solely from institutional and/or departmental sources.
Abstract
BACKGROUND
In orthopedic surgery, a patient blood management program (PBM) has been proposed to reduce blood transfusion. The aim of this observational study was to assess, within a PBM, the specific efficacy of preoperative erythropoietin (EPO).
STUDY DESIGN AND METHODS
In a single hospital, 723 patients undergoing elective primary hip or knee arthroplasty were prospectively studied. The PBM included EPO if preoperative hemoglobin was lower than 13 g/dL, intraoperative administration of tranexamic acid, use of recommended transfusion thresholds, and postoperative infusion of iron. Blood transfusion and hemoglobin were noted until discharge. Major thromboembolic or cardiovascular events were assessed during admission and 1 month after discharge.
RESULTS
Transfusion was noted in 2.5% patients with EPO. Transfusion rate was higher in patient for whom EPO was not indicated (13.6% transfusion rate; odds ratio [OR], 13.7; 95% confidence interval [CI], 2.6-66; p = 10−3) or if erythropoietin was indicated but not administrated (36.8% transfusion rate; OR, 18.2; 95% CI, 3.9-84.5; p < 10−3). Hemoglobin was significantly higher during the postoperative period in patients with erythropoietin. At hospital discharge, 57% of patients were anemic if EPO was used compared to 88% when EPO was not indicated and 87% when EPO was indicated but not administered (p < 10−6). There were no significant differences in the odds of major complications between patients with or without EPO.
CONCLUSIONS
Within a PBM, preoperative treatment of anemia with EPO decreased both the rate of blood transfusion and postoperative anemia. Further studies are necessary to confirm these results.
CONFLICT OF INTERESTS
The authors have disclosed no conflicts of interest.
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