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Perceived barriers among physicians for stopping non–cost‐effective blood‐saving measures in total hip and total knee arthroplasties
Author(s) -
Voorn Veronique M.A.,
Marangvan de Mheen Perla J.,
Wentink Ma M.,
Kaptein Ad A.,
Koopmanvan Gemert Ankie W.M.M.,
SoOsman Cynthia,
Vliet Vlieland Thea P.M.,
Nelissen Rob G.H.H.,
BodegomVos Leti
Publication year - 2014
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12672
Subject(s) - medicine , blood management , perioperative , orthopedic surgery , total hip replacement , blood transfusion , intensive care medicine , emergency medicine , surgery , physical therapy
Background Despite evidence that the blood‐saving measures ( BSMs ) erythropoietin ( EPO ) and intra‐ and postoperative blood salvage are not (cost‐)effective in primary elective total hip and knee arthroplasties, they are used frequently in D utch hospitals. This study aims to assess the impact of barriers associated with the intention of physicians to stop BSM s. Study Design and Methods A survey among 400 orthopedic surgeons and 400 anesthesiologists within the N etherlands was performed. Multivariate logistic regression was used to identify barriers associated with intention to stop BSM s. Results A total of 153 (40%) orthopedic surgeons and 100 (27%) anesthesiologists responded. Of all responders 67% used EPO , perioperative blood salvage, or a combination. After reading the evidence on non–cost‐effective BSM s, 50% of respondents intended to stop EPO and 53% to stop perioperative blood salvage. In general, barriers perceived most frequently were lack of attention for blood management (90% of respondents), department priority to prevent transfusions (88%), and patient characteristics such as comorbidity (81%). Barriers significantly associated with intention to stop EPO were lack of interest to save money and the impact of other involved parties. Barriers significantly associated with intention to stop perioperative blood salvage were concerns about patient safety, lack of alternatives, losing experience with the technique, and lack of interest to save money. Conclusion Physicians experience barriers to stop using BSM s, related to their own technical skills, patient safety, current blood management policy, and lack of interest to save money. These barriers should be targeted in strategies to make BSM use cost‐effective.