CONTRIBUTION OF PREOPERATIVE USE OF SYNTHETIC BETA ERYTHROPOEITIN FOR TOTAL HIP REPLACEMENT

Abstract

Purpose of the study: Earlier studies have demonstrated that the use of synthetic alpha-erythropoeitin can reduce the need for perioperative transfusions in orthopaedic surgery. The purpose of our study was to evaluate the effect of administering synthetic beta erythropoeitin (betaEPO) on the preoperative serum haemoglobin level in patients scheduled for total hip replacement (THR).

Material and Methods: Three groups of patients were studied. In the EPO group (15 patients) the haemoglobin level 30 days before surgery was 13 g/dl. If there were no contraindications, patients in this group were given a subcutaneous injection of betaEPO (Néorecormon^® 30,000 units in prefilled syringes) four times (days -21, -14, -7, -1). In group C the haemoglobin level was greater than 13 g/dl and no betaEPO was administered. In the third group (control group), 42 patients had a serum haemoglobin level less than 13 g/dl but were not given betaEPO. The patients were not randomised. The serum haemoglobin level was measured the day before surgery (day -1), the day after surgery (day +1), and the fifth postoperative day (day +5). Data collected were body mass index (BMI), operative time, and number of blood transfusions (cell-saver, auto-, allo-transfusion). Total red cell loss was calculated thanks to a standardized method. P< 0.05 was considered significant.

Results: The three groups were comparable preoperatively for age, gender and BMI and operatively for operative time and blood loss. Haemoglobin level was significantly higher in group C and EPO at day -1 and day +1 compared with the control group. Increase in haemoglobin level was 2.76 g/dl in the EPO group versus 0.05 and 0.04 in group C and controls (p< 0.001). Significantly fewer patients were transfused in group EPO (7%) and group C (12%) compared with controls (60%, p< 0.001). Similarly fewer packed cell units transfused was required in groups C and EPO versus the controls. The duration of the hospital stay was shorter in group C than in group EPO, which in turn was shorter than for the control group (p=0.02).

Discusssion and conclusion: A low haemoglobin level preoperatively is a risk factor for perioperative transfusion in patients undergoing THR. Preoperative administration of beta EPO, by increasing the haemoglobin level just before surgery, significantly reduces the need for blood transfusions and thus reduces the risk of complications related to such transfusions. This method can also avoid the use of autotransfusions which can favour pre and postoperative anaemia. Broader indications in orthopaedic surgery or in traumatology for the use of EPO should be implemented in order to reduce the number of operated patients requiring transfusion.