TY - JOUR
T1 - Blood Management Strategies to Reduce Transfusions After Elective Lower-Extremity Joint Arthroplasty Surgeries
T2 - One Tertiary Care Hospital’s Early Experience With an Alternative Payment Model—a Total Joint “Bundle”
AU - Kansagra, Ankit
AU - Andrzejewski, Chester
AU - Krushell, Robert
AU - Lehman, Andrew
AU - Greenbaum, Jordan
AU - Visintainer, Paul
AU - McGirr, Joan
AU - Mahoney, Kathleen
AU - Cloutier, Darlene
AU - Ehresman, Alice
AU - Stefan, Mihaela S.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post. Fractional logistic regression was used to describe differences between various intervention periods. During the study period, 2511 patients underwent TJA. Compared with the preintervention period, there was 81.8% decrease in total units of RBCT during the postintervention period. Using activity-based costing (~$1000/unit), the annualized saving in RBC expenditure was $480 000. A multidisciplinary approach can be successful and sustainable in reducing RBCT and its associated costs for patients undergoing TJA.
AB - Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post. Fractional logistic regression was used to describe differences between various intervention periods. During the study period, 2511 patients underwent TJA. Compared with the preintervention period, there was 81.8% decrease in total units of RBCT during the postintervention period. Using activity-based costing (~$1000/unit), the annualized saving in RBC expenditure was $480 000. A multidisciplinary approach can be successful and sustainable in reducing RBCT and its associated costs for patients undergoing TJA.
KW - blood transfusion
KW - health care cost
KW - joint arthroplasty
KW - quality improvement
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U2 - 10.1177/1062860616687035
DO - 10.1177/1062860616687035
M3 - Article
C2 - 28107785
AN - SCOPUS:85034958636
SN - 1062-8606
VL - 32
SP - 668
EP - 674
JO - American Journal of Medical Quality
JF - American Journal of Medical Quality
IS - 6
ER -