{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T20:36:30Z","timestamp":1785270990613,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/medicina62050942","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T08:06:26Z","timestamp":1779696386000},"page":"942","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Patient Blood Management in Total Hip and Knee Arthroplasty Before, During, and After the COVID-19 Pandemic: A Single-Center Retrospective Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"given":"Alessandra","family":"De Angelis","sequence":"first","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6342-2740","authenticated-orcid":false,"given":"Marco","family":"Minelli","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Pagot","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Martorelli","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Simili","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinzia Elisabetta","family":"De Grandis","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6776-1830","authenticated-orcid":false,"given":"Marco","family":"Scardino","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2106\/JBJS.17.01617","article-title":"Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030","volume":"100","author":"Sloan","year":"2018","journal-title":"J. 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