Preoperative Blood Management Strategy for Elective Hip and Knee Arthroplasty

Duke Perioperative Enhancement Team (POET)

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)376-383
Number of pages8
JournalJournal for Healthcare Quality
Issue number6
StatePublished - Nov 1 2019


  • anemia
  • optimization
  • quality
  • safety
  • transfusion

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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