Periacetabular osteotomy (PAO) is a demanding procedure that puts patients at risk for potentially significant blood loss, and blood transfusions. Avoidance of transfusions in otherwise healthy young patients is important. This project was designed to study the effectiveness of our blood conservation efforts.

178 consecutive PAOs performed in one hospital by one surgeon (RFS) from 2008 to 2016 were reviewed retrospectively. PAO's were performed in other hospitals, too, but a majority were from the study group hospital. Data were collected from digitalized patient office charts and hospital electronic medical records. Collected data were analyzed for categorical associations between blood loss, demographic data, and transfusion risks.

Over the past 27 months, the transfusion rate in 63 consecutive patients has been reduced to Zero. Discontinuation of drains, use of TXA, spinal anesthesia, reducing trigger for transfusion to Hgb of <7, cell saver use in all cases, and careful intraop coagulation, among others, have been incrementally incorporated. The overall transfusion rate was 10.7% for all patients. In the early years of this study, prior to adoption of all of these blood conservation measures, the transfusion rate was 12.5%. Over the past four years the transfusion rate was 1.5%. Over the last two years it has been zero.

There is little data specifically regarding transfusion rates in PAOs but this study establishes that an aggressive approach to blood saving techniques and limitation of bleeding can reduce the risk of transfusion to virtually zero in this population of mostly young patients.

Allogenic blood transfusions are frequent sequellae of hip and knee arthroplasty with potentially deleterious consequences. A prospective collection of a comprehensive data set of 1,185 knee and 1,064 hip arthroplasty patients including primary and revision surgeries was completed with analysis of allogenic and predonated blood usage, blood salvage systems and costs. The most effective strategy in reducing allogenic blood transfusion is the use of a blood salvage system. The most expensive strategy is the use of blood salvage systems with predonation. The least expensive and least effective strategy is no predonation of blood and no blood salvaging system.

The purpose of this study is to evaluate the usage, effectiveness and cost of blood salvage technologies in total hip and knee arthroplasty.

The most effective strategy in reducing allogenic blood transfusion is the use of a blood salvage system. The most expensive strategy is the use of blood salvage systems with predonation. The least expensive and least effective strategy is no predonation of blood and no blood salvaging system. More than half of the predo-nated blood collected was never used.

Blood loss in total hip and knee arthroplasty can have significant deleterious physiologic effects on patients. There are potential health risks with allogenic blood transfusion as well as patient anxiety toward allogenic transfusion. Recent advances in blood management provide additional options that need further evaluation.

The lowest cost strategy was no predonation and no blood salvage system at an average of $30 per patient, but with a 14% incidence of allogenic transfusion. Pre-donation alone had a cost of $330 with a 12% transfusion rate. Predonated blood was wasted in 60% of knee arthroplasties and 48% of hip arthroplasties. The Consta Vac and OrthoPAT blood salvage systems had a cost of $110 and $365 with 5% and 7% transfusion rate, respectively.

A prospective collection of a two-year comprehensive data set of 1,185 knee and 1,064 hip arthroplasty patients including both primary and revision surgeries was completed. Analysis of blood counts, allogenic and predonated blood usage, blood salvage systems, length of stay, demographics and costs were performed.

Allogenic blood transfusions are frequent sequellae of hip and knee arthroplasty with potentially deleterious consequences. A prospective collection of a comprehensive data set of 1,185 knee and 1,064 hip arthroplasty patients including primary and revision surgeries was completed with analysis of allogenic and predonated blood usage, blood salvage systems and costs. The most effective strategy in reducing allogenic blood transfusion is the use of a blood salvage system. The most expensive strategy is the use of blood salvage systems with predonation. The least expensive and least effective strategy is no predonation of blood and no blood salvaging system.

The purpose of this study is to evaluate the usage, effectiveness and cost of blood salvage technologies in total hip and knee arthroplasty.

The most effective strategy in reducing allogenic blood transfusion is the use of a blood salvage system. The most expensive strategy is the use of blood salvage systems with predonation. The least expensive and least effective strategy is no predonation of blood and no blood salvaging system. More than half of the predonated blood collected was never used.

Blood loss in total hip and knee arthroplasty can have significant deleterious physiologic effects on patients. There are potential health risks with allogenic blood transfusion as well as patient anxiety toward allogenic transfusion. Recent advances in blood management provide additional options that need further evaluation.

The lowest cost strategy was no predonation and no blood salvage system at an average of $30 per patient, but with a 14% incidence of allogenic transfusion. Pre-donation alone had a cost of $330 with a 12% transfusion rate. Predonated blood was wasted in 60% of knee arthroplasties and 48% of hip arthroplasties. The Consta Vac and OrthoPAT blood salvage systems had a cost of $110 and $365 with 5% and 7% transfusion rate, respectively.

A prospective collection of a two-year comprehensive data set of 1,185 knee and 1,064 hip arthroplasty patients including both primary and revision surgeries was completed. Analysis of blood counts, allogenic and predonated blood usage, blood salvage systems, length of stay, demographics and costs were performed.