20 years of blood management and VTE prevention in orthopedic surgery in the Netherlands - a nationwide survey.

INTRODUCTION

Advances in arthroplasty care have progressively improved patient outcomes, including reduced bleeding and venous thromboembolism rates. Consequently, blood-saving measures applied pre-, peri- and postoperatively as well as thromboprophylaxis regimens have evolved over time. To evaluate these developments, we conducted a 2023 follow-up to the national surveys from 2002, 2007 and 2012, examining current blood-saving strategies and thromboprophylaxis use in The Netherlands.

MATERIALS AND

METHODS

In 2023, a questionnaire designed to match the previous surveys was distributed to all orthopedic departments in the Netherlands. The collected data were summarized and compared with previous findings.

RESULTS

Responses were received from 61% of the Dutch orthopedic departments. Blood-saving practices have shifted significantly toward the use of tranexamic acid, accompanied by a decline in other measures. In particular, the use of drains, blood transfusions, and erythropoietin supplementation has decreased substantially. Thromboprophylaxis protocols showed fewer changes, although the average duration of prophylaxis has shortened, with low-molecular-weight heparin remaining the most commonly used anticoagulant.

CONCLUSIONS

Advances in surgical techniques and postoperative care around arthroplasty appear to have reduced concerns about perioperative blood loss to a level where the use of tranexamic acid alone is considered sufficient to control blood loss, rendering many previously popular perioperative blood-saving measures redundant. In contrast, despite a decline in thrombotic complications associated with the introduction of fast-track surgery, thromboprophylaxis protocols have remained largely unchanged. These findings highlight the opportunity to further balance the risks of bleeding and thrombosis following arthroplasty.