Hourlier Hervé, Fricault Guillaume, Fennema Peter
Polyclinique de la Thiérache, Wignehies, France.
CHU de Saint Pierre, Saint Pierre, France.
Arch Orthop Trauma Surg. 2025 Jan 24;145(1):143. doi: 10.1007/s00402-025-05764-5.
Patients undergoing total hip arthroplasty (THA) with preoperative anemia are at higher risk for transfusion. Blood-conserving interventions can reduce perioperative transfusions. This retrospective study evaluates the efficacy and safety of a patient blood management (PBM) protocol in elective primary THA patients with preoperative anemia.
We analyzed data from a prospectively collected database of THAs performed consecutively from January 2013 to October 2023. The patients were grouped based on baseline hemoglobin (Hb) levels, as follows: <12 g/dL (group 1) and ≥ 12 g/dL (group 2). The PBM protocol included optimized preoperative epoetin (EPO) for Hb < 11 g/dL, bleeding reduction measures, and restrictive transfusion thresholds. Blood loss was measured using a bleeding index (BI-7), accounting for Hb decrease from admission to the 7th postoperative day and total transfused units. Multiple linear regression was used to assess the differences in BI-7.
Of the 1,442 patients, 104 (7%) had Hb < 12 g/dL (group 1). Among these, 46 (45%) received EPO, with none requiring transfusion in the first week. The mean adjusted BI-7 was 2.3 g/dL (95% CI, 2.1 to 2.6) in group 1 and 2.7 g/dL (95% CI, 2.6 to 2.7) in group 2, showing a significant difference (-0.4 g/dL; 95% CI, -0.6 to -0.1; p < 0.001).
THA patients with baseline Hb < 12 g/dL had a zero-transfusion rate and significantly lower blood loss than those with Hb ≥ 12 g/dL. Optimizing preoperative Hb levels above 12 g/dL is not necessary for patients undergoing standard THA. Optimizing preoperative Hb may not be necessary for patients with baseline anemia due to their low blood loss. The PBM protocol was effective in conserving blood, time, and resources, offering a viable alternative for blood conservation in elective hip arthroplasty.
术前贫血的全髋关节置换术（THA）患者输血风险更高。血液保护干预措施可减少围手术期输血。本回顾性研究评估了患者血液管理（PBM）方案在择期初次行THA且术前贫血患者中的有效性和安全性。
我们分析了2013年1月至2023年10月连续进行的THA前瞻性收集数据库中的数据。患者根据基线血红蛋白（Hb）水平分组如下：<12 g/dL（第1组）和≥12 g/dL（第2组）。PBM方案包括针对Hb<11 g/dL优化术前促红细胞生成素（EPO）、减少出血措施和限制性输血阈值。使用出血指数（BI-7）测量失血量，该指数考虑了从入院到术后第7天Hb的下降以及输注的总单位数。采用多元线性回归评估BI-7的差异。
1442例患者中，104例（7%）Hb<12 g/dL（第1组）。其中，46例（45%）接受了EPO，第一周内无人需要输血。第1组的平均调整后BI-7为2.3 g/dL（95%CI，2.1至2.6），第2组为2.7 g/dL（95%CI，2.6至2.7），差异有统计学意义（-0.4 g/dL；9%CI，-0.6至-0.1；p<0.001）。
基线Hb<12 g/dL的THA患者输血率为零，失血量显著低于Hb≥12 g/dL的患者。对于接受标准THA的患者，将术前Hb水平优化至12 g/dL以上没有必要。由于基线贫血患者失血量低，优化术前Hb可能也没有必要。PBM方案在节约血液、时间和资源方面有效，为择期髋关节置换术的血液保护提供了可行的替代方案。
