Patient Blood Management in Total Hip and Knee Arthroplasty Before, During, and After the COVID-19 Pandemic: A Single-Center Retrospective Cohort Study.

Background and

Objectives

Patient blood management (PBM) strategies are effective in reducing transfusion requirements and improving perioperative outcomes in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The SARS-CoV-2 pandemic profoundly disrupted hospital organization and limited the application of established PBM protocols. This study assessed the impact of COVID-19-related organizational disruption on PBM implementation and perioperative outcomes in primary total hip and knee arthroplasty. Materials and

Methods

This monocentric retrospective study included consecutive patients undergoing primary unilateral THA or TKA between January 2019 and February 2023. Patients were stratified into three periods: pre-COVID-19, during COVID-19, and post-COVID-19. Primary outcomes included transfusion rate, allocated RBC units, PRM transfer, hospital length of stay, and postoperative day-4 hemoglobin levels. Secondary outcomes were factors associated with postoperative day-4 hemoglobin and PRM admission.

Results

A total of 5789 patients were included: 1889 in the pre-COVID-19 period, 1416 during COVID-19, and 2484 post-COVID-19. Despite reduced PBM implementation during the COVID-19 period, postoperative Hb levels and transfusion rates remained stable across groups. The number of allocated red blood cell units increased without a corresponding rise in transfusion rates, suggesting a precautionary allocation strategy. A descriptive reduction in median length of stay was observed in the post-COVID-19 phase. A significant decrease in the proportion of patients transferred to Physical and Rehabilitation Medicine departments during the COVID-19 and in the post-COVID-19 period was observed. Multivariable analysis identified age, BMI, preoperative Hb, sex, procedure type, IVFCM administration, and transfusion as predictors of postoperative day-4 Hb, while age, IVFCM administration, transfusion, procedure type, and study period were associated with PRM admission.

Conclusions

Despite major organizational disruption, perioperative hemoglobin levels and transfusion rates remained stable, while hospital length of stay decreased. These findings may partly reflect strict selection of already optimized patients; however, this strategy is not equivalent to structured PBM and cannot be generalized to an unselected arthroplasty population.