Cambridge Journals Online

Effects of epoetin alfa on blood transfusions and postoperative recovery in orthopaedic surgery: the European Epoetin Alfa Surgery Trial (EEST)

E. W. G. Weber a1p1, R. Slappendel a1c1, Y. Hémon a2, S. Mähler a3, T. Dalén a4, E. Rouwet a5, J. van Os a6, A. Vosmaer a7 and P. ven der Ark a8 a1 Sint Maartenskliniek, Nijmegen, The Netherlands a2 Hôpital Ste-Marguerite, Marseille, France a3 Kreiskrankenhaus, Langenau, Germany a4 Norrlands Universitetssjukhus, Umeå, Sweden a5 Medisch Spectrum Twente, Enschede, The Netherlands a6 Maasland Ziekenhuis, Sittard, The Netherlands a7 Ikazia Ziekenhuis, Rotterdam, The Netherlands a8 Environ Netherlands B.V., Zeist, The Netherlands

Article author query weber ew     slappendel r     hemon y     mahler s     dalen t     rouwet e     van os j     vosmaer a     van der ark p

Summary

Background and objective: Preoperative epoetin alfa administration decreases transfusion requirements and may reduce transfusion complications, such as postoperative infection due to immune suppression and thus hospitalization time. This study examined the impact of preoperative epoetin alfa administration on postoperative recovery and infection rate.

Methods: In an open randomized controlled multicentre trial in patients undergoing orthopaedic surgery, the effects of preoperative administration of epoetin alfa vs. routine care were compared in six countries. Haemoglobin (Hb) values, transfusions, time to ambulation, time to discharge, infections and safety were evaluated in patients with preoperative Hb concentrations 10–13g dL⁻¹ (on-treatment population: epoetin n = 460; control n = 235), from study entry until 4–6 weeks after surgery. Outcome was also compared in patients with and without transfusion.

Results: Epoetin-treated patients had higher Hb values from the day of surgery until discharge (P < 0.001) and lower transfusion rates (12% vs. 46%; P < 0.001). Epoetin treatment delivered no significant effect on postoperative recovery (time to ambulation, time to discharge and infection rate). However, the time to ambulation (3.8 ± 4.0 vs. 3.1 ± 2.2 days; P < 0.001) and the time to discharge (12.9 ± 6.4 vs. 10.2 ± 5.0 days; P < 0.001) was longer in the transfused than in the non-transfused patients. Side-effects in both groups were comparable.

Conclusions: Epoetin alfa increases perioperative Hb concentration in mild-to-moderately anaemic patients and thus reduces transfusion requirements. Patients receiving blood transfusions require a longer hospitalization than non-transfused patients.