The Use of Preoperative Epoetin-α in Revision Hip Arthroplasty
Lawrence A Delasotta*, 1, Ashwin Rangavajjula2, Michael L Frank 3, Jamie Blair 4, Fabio Orozco 2, 5, Alvin Ong 2, 5
1 Temple University, Department of Surgery, Philadelphia, PA 19140, USA
2 Thomas Jefferson University, Philadelphia, PA 19107, USA
3 The Richard Stockton College of New Jersey, Pomona, NJ 08240, USA
4 Egg Harbor Township, New Jersey 08234, USA
5 The Rothman Institute, AtlantiCare Regional Medical Center, USA
To evaluate the efficacy of preoperative epoetin-α on the revision hip arthroplasty patient. We hypothesized that epoetin-α will reduce blood transfusion. A pertinent review of the literature is provided.
Forty-six patients were retrospectively reviewed. Sixteen patients received epoetin-α. Patients were case matched by age, preoperative hemoglobin, surgery, gender, and BMI. The clinical triggers for blood transfusion during or after the procedure were determined based on peri- and postoperative hemoglobin levels, ASA score, and/or clinical symptoms consistent with anemia. Blood salvage was not used.
Blood transfusion and length of stay were decreased in the epoetin-α group. Hemoglobin in the intervention group increased from 12.0 to 14.5, preoperatively. Patients who received epoetin-α were 0.78 (RR=0.225) times as likely to receive a transfusion. Number Needed to Treat (NNT) to avoid one allogeneic transfusion was 1.84. Age, Gender, BMI, ASA, total and hidden blood loss, preoperative Iron supplements, preop Hct, preop PLT, PT, PTT, and INR were similar. One (6.0%) patient developed an uncomplicated deep venous thrombosis in the intervention group.
The mildly anemic revision hip arthroplasty patient is at increased risk for transfusion. Epoetin-α increased preoperative hemoglobin counts and reduced transfusions in this study; it also decreased patient length of hospital stay likely allowing for an earlier readiness to resume normal activities and/or meet short-term milestones. A randomized study to evaluate the direct and indirect costs of such a treatment methodology in the mildly anemic revision patient may be warranted.
Keywords: Anemia, orthopedic surgery, autologous blood donation, blood transfusion, epoetin-α, revision total hip arthroplasty.
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
* Address correspondence to this author at 3401 N. Broad Street, Parkinson Pavilion, Suite 400, Philadelphia, PA 19140, USA; Tel: 215-707-3632; Fax: 215-707-1915; E-mail: firstname.lastname@example.org