The Use of Preoperative Epoetin-α in Revision Hip Arthroplasty.

Authors

Lawrence A Delasotta, Temple University, Department of SurgeryFollow
Ashwin Rangavajjula, Thomas Jefferson UniversityFollow
Michael L Frank, The Richard Stockton College of New JerseyFollow
Jamie Blair, Egg Harbor Township, New Jersey 08234, USAFollow
Fabio Orozco, Thomas Jefferson University; The Rothman Institute, AtlantiCare Regional Medical CenterFollow
Alvin Ong, Thomas Jefferson University; The Rothman Institute, AtlantiCare Regional Medical CenterFollow

Document Type

Article

Publication Date

1-1-2012

Comments

This article has been peer reviewed. It was published in: Open orthopaedics journal.

2012;6:179-83.

The published version is available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358717/. DOI: 10.2174/1874325001206010179.

Copyright © Delasotta et al.; Licensee Bentham Open.

Abstract

PURPOSE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Recommended Citation

Delasotta, Lawrence A; Rangavajjula, Ashwin; Frank, Michael L; Blair, Jamie; Orozco, Fabio; and Ong, Alvin, "The Use of Preoperative Epoetin-α in Revision Hip Arthroplasty." (2012). Rothman Institute Faculty Papers. Paper 35.
https://jdc.jefferson.edu/rothman_institute/35