Blood Management Strategies in Total Knee Arthroplasty

A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

Bacteremia in a Multilevel Geriatric Hospital, Second Look 5 Years Later.

Aims: In a previous study (2004) we explored the clinical and microbiological aspects of bloodstream infections (BSI) in a multilevel geriatric hospital, and concluded that follow up and monitoring of these parameters is warranted. The purpose of this new study is to evaluate the current BSI status and compare these data to those obtained previously. Study Design and Methodology: We implemented the methodology developed for the initial study. Clinical features, microbiological characteristics and outcome of BSI over the year 2009 were investigated. Results: The rate of positive blood cultures was similar (10% versus 12%). The rate of BSI was 1.35 per 1000 patients in 2004 and 1.7 per 1000 in 2009. The mortality rate at 2 weeks decreased significantly (from 42% to 22.5%, p=.001). The most common isolate was Escherichia coli in both studies, followed by Proteus mirabilis. Interestingly, antibiotic susceptibility of common pathogens between 2004 and 2009 remained unchanged in 40% while increasing in 32% of cases. Conclusion: This second look at BSI and revision of BSI parameters provides updated information that may be beneficial for further follow up and antibiotic stewardship program.