Progressive implementation of patient blood management and declining transfusion rates in major orthopedic surgery. A single-centre experience

Abstract

Introduction Patient Blood Management (PBM) has become an essential component of contemporary perioperative medicine. Major orthopedic surgery has historically been associated with substantial perioperative blood loss and high allogeneic transfusion rates. The aim of this study was to describe the temporal association between the progressive implementation of a multidisciplinary PBM programme and transfusion rates in major orthopedic surgery at our institution. Materials and methods This retrospective observational single-centre study on annual institutional aggregated data included patients undergoing major orthopedic procedures, including total hip arthroplasty (THA), total knee arthroplasty (TKA), and major spine surgery (MSS), between 2012 and 2018. The PBM programme incorporated a multidisciplinary perioperative approach consisting of preoperative anemia management, restrictive transfusion thresholds, a single-unit transfusion policy, routine tranexamic acid (TXA) administration, meticulous surgical hemostasis, minimally invasive surgical techniques, and selective use of intraoperative cell salvage systems. Annual transfusion rates and PBM-related interventions were analysed over the study period for the overall cohort and separately for each procedure group. Results A total of 7,439 major orthopedic procedures were analysed. Overall transfusion rates decreased from 38.1% in 2012 to 9.2% in 2018, corresponding to an absolute reduction of 28.9% and a relative reduction of 76.0%. Similar reductions were observed for THA (45.0% to 13.6%), TKA (31.7% to 4.6%), and MSS (32.1% to 9.1%). Logistic regression demonstrated that each additional calendar year was associated with a significant reduction in the odds of transfusion in the overall cohort (OR 0.72, 95% CI 0.70–0.74; p < 0.001), with comparable trends observed for each surgical subgroup. During the same period, TXA utilization increased progressively, reaching a mean of 2.1 g per procedure in 2018, whereas intraoperative cell saver use became increasingly selective. Conclusion The present study demonstrates that multidisciplinary PBM implementation substantially reduces transfusion requirements in major orthopedic surgery. PBM should not be regarded as a single intervention, but rather as a coordinated perioperative strategy based on synergistic implementation of multiple blood conservation measures, resulting in improved perioperative management.

The authors' abstract, as published at the source. Frontiers in Surgery, 2026 · DOI ↗