Minimizing Blood Transfusion in Total Hip and Knee Arthroplasty Through a Multimodal Approach.

BACKGROUND: We introduced a multimodal, multidisciplinary approach to perioperative blood management aimed at reducing blood transfusions in primary knee (TKA) and hip (THA) arthroplasty. The protocol included (1) preoperative hemoglobin optimization through a multidisciplinary approach, (2) minimization of perioperative blood loss, and (3) adherence to evidence-based transfusion guidelines. METHODS: Evaluation of 1010 consecutive patients undergoing primary TKA (488) or THA (522) was performed. RESULTS: A significant reduction in the overall transfusion rate (1.4% vs 17.9%, P<.0001) resulted after algorithm introduction, when compared with the 1814 previous patients. Zero (0%) TKA and 4 (0.8%) THA patients adherent to protocol, and 4/488 (0.8%) TKA and 10/522 (1.9%) THA patients overall received transfusions. CONCLUSION: Adoption of a multimodal blood management algorithm can significantly reduce blood transfusions in primary joint arthroplasty.