CORR Insights(®): Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative.

Abstract

N umerous studies have identified the risks associated with allogeneic blood transfusion. Although most of the major complications of transfusion are rare, they can indeed be serious. These include bacterial or viral transmission, immunomodulation, transfusion-related lung injury, and death [3, 4]. In addition, surgical patients who receive allogeneic blood transfusion have been shown to have longer hospital stays and higher risks of complications [2]. Despite these documented adverse events, orthopaedic surgeons remain avid consumers of allogeneic blood transfusions [5, 6]. Nationally, orthopaedic surgeons account for 10% of all blood transfused [7]. In fact, in the current study by Markel et al., prior to implementation of a quality initiative program to reduce transfusion rates, 16% of patient undergoing primary total joint arthroplasty received a transfusion and 6.5% of those transfused had Hemoglobin levels above 8mg/dL,which is of the established recommendation for transfusion by the American Association of Blood Banks (AABB) [1]. I do not believe their practice site is exceptional in this way; despite published evidence based guidelines on recommendations for transfusion, there remains substantial variation in transfusion practice throughout the country following total joint arthroplasty. In the current study by Markel and colleagues, the authors demonstrate that the implementation of a quality initiative program dramatically reduced the proportion ofpatients receivinga transfusion after joint arthroplasty—from 16% to 3%. More importantly, the proportion of patients receiving transfusion for hemoglobin levels over 8% (transfusions outside the recommendations of the AABB), diminished by 80%.