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Erythropoietin is an effective clinical modality for reducing RBC transfusion in joint surgery

[Le traitement à l’érythropoïétine réduit efficacement les transfusions de culots globulaires en chirurgie orthopédique]

Keyvan Karkouti, MD^*,, Stuart A. McCluskey, MD^*, Lucia Evans, RN, Nizar Mahomed, MD, Mohammed Ghannam, BSc^* and Roderrick Davey, MD

^* From the Departments of Anesthesia and
Health Policy, Management, and Evaluation;
the Department of Nursing, Perioperative Blood Conservation;
the Department of Surgery, Division of Orthopedic Surgery; University Health Network, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Keyvan Karkouti, Department of Anesthesia, Toronto General Hospital, Eaton North, 3-405, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. E-mail: keyvan.karkouti{at}uhn.on.ca

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·L^–1) 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·L^–1 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·L^–1. 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.

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