Good Riddance to Allogeneic Transfusions?
The use of allogeneic transfusions in managing blood loss in total knee arthroplasty (TKA) is on the decline…and good riddance says new research from Maryland.
“Are Allogeneic Transfusions Decreasing in Total Knee Arthroplasty Patients? National Inpatient Sample 2009 to 2013,” appeared in the December 20, 2017 edition of The Journal of Arthroplasty.
Ronald E. Delanois, M.D., division director of the Center for Joint Preservation and Replacement (CJPR), the director of Hip, Knee and Shoulder Surgery, Research Division and Research Fellowship Program at the Rubin Institute for Advanced Orthopedics at Sinai Hospital of Baltimore in Maryland and the study’s senior author told OTW, “Total knee arthroplasty has been associated with considerable blood loss which can lead to postoperative anemia.”
“This postoperative anemia is of particular importance when considering elderly populations that make up the majority of TKA recipients. As such, these groups are at higher risk for anemia-associated events (i.e., heart attack and cerebrovascular injury).”
“Allogeneic transfusion is often used in these settings; however, its use has been associated with adverse events such as blood-related reactions and infection. Increasing efforts to improve care quality (i.e., mitigate adverse events) while reducing costs have prompted new blood conservation protocols at varying institutions nationwide.”
“This study assessed the use of allogeneic transfusions nationwide during inpatient TKA procedures with the primary aim of assessing usage trends, costs, and associated in-patient hospital adverse events. These endpoints are of particular importance when considering legislative pressure placed upon arthroplasty providers to reduce all associated costs while improving quality.”
Chukwuweike Gwam, M.D., first author on the study and research fellow at The Rubin Institute, told OTW, “The study uses the National Inpatient Sample database which is a valid representation of 95% of all non-federal hospitalizations in the United States. We used general linear modeling to adjust for variability associated hospital-level characteristics. The main strength of this study is its large sample size (exceeding over 3 million hospitalizations) which allowed us to assess trends in allogeneic transfusions and costs associated with hospitalizations that involved allogeneic transfusions.”
“There has been a steady decline in allogeneic transfusion usage between 2009 and 2013 for TKA related hospitalizations. Hospitalizations that result in allogeneic blood transfusion usage are associated with significantly increased costs and lengths of stay. The goal of today’s healthcare is to reduce costs and improve quality.”
“Allogeneic transfusions may be reduced with the use of evidenced-based protocol. Reduction in allogeneic transfusion usage may lead to decreases in costs of care and improvements in care quality by affecting lengths of stay and reducing transfusion related complications.”
“Nationwide efforts to implement blood conservation protocols during TKA hospitalizations has led to the decreased usage of allogeneic transfusion. Despite this, use of allogeneic transfusion is still associated with a significant increase in costs and higher odds of short-term adverse events (i.e., pulmonary embolism). Nonetheless, continued efforts from the orthopedic community have led to decreased allogeneic blood transfusion for TKA recipients in the U.S.”
