Abstract
Purpose
Efficacy trials of preoperative erythropoietin therapy (PET) recommend a dosing schedule that cannot always be adhered to in everyday clinical practice. Consequently, we instituted a flexible dosing schedule and routinely offered it to anemic patients [hemoglobin (Hb)] # 130 g.L1) undergoing total joint arthroplasty (TJA). The purpose of this observational, cohort study was to assess the effectiveness of this practice in reducing red blood cell (RBC) transfusion.
Methods
After obtaining Institutional Ethics Board approval, data were collected prospectively on all patients who underwent TJA at our institution from July 1999 to June 2003. Patients with baseline Hb # 130 g.L1 were offered PET as follows: one to three sc injections (20,000 IU for those # 70 kg, and 40,000 IU for those > 70 kg) every three to seven days before surgery. Since treatment was not randomly assigned, multivariable logistic regression analysis and propensity score case-control matching were used to adjust for baseline differences in patient demographics and perioperative risk factors for RBC transfusion. The adjusted relationship between PET and RBC transfusion was then determined.
Results
Of the 1,782 patients that underwent TJA during the study period, 770 (47.9%) had a Hb < 130 g.L1. Of these patients, 214 received PET and their RBC transfusion rate was 16.4%, whereas the transfusion rate was 56.1% in those who did not receive PET (P < 0.0001). The adjusted odds ratio of RBC transfusion with PET was 0.33 (95% confidence interval = 0.21-0.49).
Conclusion
PET, used as part of routine clinical practice, is an effective blood conservation modality.
Objectif
Les études de l’efficacité du traitement préopératoire à l’érythropoïétine (TPE) recommandent un dosage programmé difficile à observer au quotidien. Nous avons donc institué un programme flexible et l’avons offert automatiquement aux patients anémiques [hémoglobine (Hb)] # 130 g.L1) devant subir une arthroplastie articulaire totale (AAT). Notre étude observationnelle d’une cohorte veut évaluer l’efficacité de cette pratique.
Méthode
Après avoir obtenu l’approbation du Comité d’éthique de l’institution, nous avons recueilli les données prospectives sur les patients qui ont subi une AAT entre juillet 1999 et juin 2003 à notre hôpital. Le TPE a été offert aux patients dont l’Hb de base était # 130 g.L“1 : de une à trois injections sc (20 000 UI pour un poids # 70 kg et 40 000 UI pour un poids > 70 kg) tous les trois à sept jours avant l’opération. Le traitement n’étant pas assigné au hasard, une analyse de régression logistique multivariée et un appariement sujettémoin du score de propension ont été utilisés pour ajuster les différences dans les caractéristiques des patients et les facteurs de risque périopératoires de transfusion de CG. La relation ajustée entre le TPE et la transfusion de CG a ensuite été déterminée.
Résultats
Des 1 782 patients qui ont subi une AAT pendant la période étudiée, 770 (47,9 %) avaient une Hb < 130 g.L1. De ces patients, 214 ont reçu le TPE et leur taux de transfusion de CG a été de 16,4 %, tandis qu’il a été de 56,1 % chez ceux qui n’ont pas reçu de TPE (P < 0,0001). Le risque relatif ajusté de transfusion de CG avec le TPE était de 0,33 (intervalle de confiance de 95 % = 0,21-0,49).
Conclusion
Le TPE utilisé dans le cadre d’une pratique clinique courante est une modalité efficace de conservation du sang.
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Dr. Karkouti is supported by a CIHR/CBS New Investigator Award. Drs McCluskey and Karkouti have received speaker’s fees and research support from Ortho-Biotech.
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McCluskey, S.A., Ghannam, M., Karkouti, K. et al. Erythropoietin is an effective clinical modality for reducing RBC transfusion in joint surgery. Can J Anesth 52, 362–368 (2005). https://doi.org/10.1007/BF03016277
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DOI: https://doi.org/10.1007/BF03016277