Indications for perioperative blood transfusion in orthopedic surgery

SUMMARY Today’s aging population has resulted in an increase in the number of major orthopedic surgical interventions in the elderly. High perioperative blood losses, together with a reduced tolerance to anemia, raise the likelihood of transfusion in this patient subgroup. The expected cost explosion in the transfusion system (cost‐intensive quality management, imbalance between the number of donors and recipients) as well as the remaining transfusion‐related risks of hemolysis, infection and immunosuppression demonstrate the high socioeconomical importance of developing institutional transfusion programs. This article summarizes (i) the pathophysiology of anemia compensation; (ii) the decision‐making process for transfusion in healthy patients and patients with cardiovascular disease; and (iii) current pre‐ and intraoperative techniques aimed at reducing allogeneic transfusion in orthopedic patients.