{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:55:30Z","timestamp":1790916930070,"version":"4.1.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Patient Blood Management (PBM) has become an essential component of contemporary perioperative medicine. Major orthopedic surgery has historically been associated with substantial perioperative blood loss and high allogeneic transfusion rates. The aim of this study was to describe the temporal association between the progressive implementation of a multidisciplinary PBM programme and transfusion rates in major orthopedic surgery at our institution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective observational single-centre study on annual institutional aggregated data included patients undergoing major orthopedic procedures, including total hip arthroplasty (THA), total knee arthroplasty (TKA), and major spine surgery (MSS), between 2012 and 2018. The PBM programme incorporated a multidisciplinary perioperative approach consisting of preoperative anemia management, restrictive transfusion thresholds, a single-unit transfusion policy, routine tranexamic acid (TXA) administration, meticulous surgical hemostasis, minimally invasive surgical techniques, and selective use of intraoperative cell salvage systems. Annual transfusion rates and PBM-related interventions were analysed over the study period for the overall cohort and separately for each procedure group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 7,439 major orthopedic procedures were analysed. Overall transfusion rates decreased from 38.1% in 2012 to 9.2% in 2018, corresponding to an absolute reduction of 28.9% and a relative reduction of 76.0%. Similar reductions were observed for THA (45.0% to 13.6%), TKA (31.7% to 4.6%), and MSS (32.1% to 9.1%). Logistic regression demonstrated that each additional calendar year was associated with a significant reduction in the odds of transfusion in the overall cohort (OR 0.72, 95% CI 0.70\u20130.74;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), with comparable trends observed for each surgical subgroup. During the same period, TXA utilization increased progressively, reaching a mean of 2.1\u2005g per procedure in 2018, whereas intraoperative cell saver use became increasingly selective.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The present study demonstrates that multidisciplinary PBM implementation substantially reduces transfusion requirements in major orthopedic surgery. PBM should not be regarded as a single intervention, but rather as a coordinated perioperative strategy based on synergistic implementation of multiple blood conservation measures, resulting in improved perioperative management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1918812","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:38:45Z","timestamp":1790915925000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Progressive implementation of patient blood management and declining transfusion rates in major orthopedic surgery. A single-centre experience"],"prefix":"10.3389","volume":"13","author":[{"given":"Matic","family":"Kolar","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University Medical Centre Ljubljana","place":["Ljubljana, Slovenia"]},{"name":"Faculty of Medicine, University of Ljubljana","place":["Ljubljana, Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo\u0161tjan","family":"Kocjan\u010di\u010d","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Medical Centre Ljubljana","place":["Ljubljana, Slovenia"]},{"name":"Faculty of Medicine, University of Ljubljana","place":["Ljubljana, Slovenia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"191","DOI":"10.2450\/2019.0109-19","article-title":"Patient blood management: a revolutionary approach to transfusion medicine","volume":"17","author":"Franchini","year":"2019","journal-title":"Blood Transfus"},{"key":"B2","first-page":"3","article-title":"Why should health professionals be concerned about blood management and blood conservation?","volume":"2","author":"Isbister","year":"2005","journal-title":"Updates Blood Conserv Transfus Altern"},{"key":"B3","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1093\/bja\/aes166","article-title":"Patient blood management is a win-win: a wake-up call","volume":"108","author":"Spahn","year":"2012","journal-title":"Br J Anaesth"},{"key":"B4","doi-asserted-by":"publisher","first-page":"S63","DOI":"10.1016\/j.arth.2021.08.018","article-title":"Who is still receiving blood transfusions after primary and revision total joint arthroplasty?","volume":"37","author":"DeMik","year":"2022","journal-title":"J Arthroplasty"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1016\/S0140-6736(11)61381-0","article-title":"Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study","volume":"378","author":"Musallam","year":"2011","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1855","DOI":"10.1016\/S0140-6736(13)60808-9","article-title":"Alternatives to blood transfusion","volume":"381","author":"Spahn","year":"2013","journal-title":"Lancet"},{"key":"B7","doi-asserted-by":"publisher","first-page":"i41","DOI":"10.1093\/bja\/aer350","article-title":"What is really dangerous: anaemia or transfusion?","volume":"107","author":"Shander","year":"2011","journal-title":"Br J Anaesth"},{"key":"B8","doi-asserted-by":"publisher","first-page":"272","DOI":"10.2106\/JBJS.L.01268","article-title":"Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty","volume":"96","author":"Friedman","year":"2014","journal-title":"J Bone Joint Surg Am"},{"key":"B9","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.1016\/j.surg.2007.06.025","article-title":"Financial and clinical outcomes associated with surgical bleeding complications","volume":"142","author":"Shander","year":"2007","journal-title":"Surg Clin North Am"},{"key":"B10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1634\/theoncologist.2011-S3-3","article-title":"Five drivers shifting the paradigm from product-focused transfusion practice to patient blood management","volume":"16","author":"Hofmann","year":"2011","journal-title":"Oncologist"},{"key":"B11","doi-asserted-by":"publisher","first-page":"23","DOI":"10.2450\/2015.0172-15","article-title":"Recommendations for the implementation of a patient blood management programme. 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