Blood Management Strategies to Reduce Transfusions After Elective Lower-Extremity Joint Arthroplasty Surgeries: One Tertiary Care Hospital's Early Experience With an Alternative Payment Model-a Total Joint "Bundle"

Am J Med Qual. 2017 Nov/Dec;32(6):668-674. doi: 10.1177/1062860616687035. Epub 2017 Jan 20.


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.

Keywords: blood transfusion; health care cost; joint arthroplasty; quality improvement.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / economics
  • Arthroplasty, Replacement, Hip / methods*
  • Arthroplasty, Replacement, Knee / economics
  • Arthroplasty, Replacement, Knee / methods*
  • Blood Loss, Surgical / prevention & control*
  • Elective Surgical Procedures
  • Erythrocyte Transfusion / economics
  • Erythrocyte Transfusion / statistics & numerical data*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Care Bundles / economics
  • Patient Care Bundles / methods*
  • Quality Improvement
  • Retrospective Studies
  • Tertiary Care Centers