***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND There are few data on the associations between anaemia , allogeneic blood transfusion ( ABT ) , patient blood management , and outcome after arthroplasty in the UK . National agencies nevertheless instruct NHS Trusts to implement blood conservation measures including preoperative anaemia management . Internationally , blood management programmes show encouraging results . METHODS We retrospectively audited 717 primary hip or knee arthroplasties in a UK general hospital and conducted regression analyses to identify outcome predictors . We used these data to modify previously published algorithms for UK practice and audited its introduction prospect ively . The retrospective audit group served as a control . RESULTS Preoperative haemoglobin ( Hb ) concentration predicted ABT ( odds ratio 0.25 per 1 g dl(-1 ) , P<0.001 ) . It also predicted the length of stay ( LOS , effect size -0.7 days per 1 g dl(-1 ) , P=0.004 ) independently of ABT , including in non-anaemic patients . Patient blood management implementation was associated with lower ABT rates for hip ( 23 - 7 % , P<0.001 ) and knee ( 7 - 0 % , P=0.001 ) arthroplasty . LOS for total hip replacement and total knee replacement decreased from 6 ( 5 - 8 ) days to 5 ( 3 - 7 ) and 4 ( 3 - 6 ) days , respectively , after algorithm implementation ( P<0.001 ) . The all-cause re-admission rate within 90 days decreased from 13.5 % ( 97/717 ) before to 8.2 % ( 23/281 ) after algorithm implementation ( P=0.02 ) . CONCLUSIONS We conclude that preoperative Hb predicts markers of arthroplasty outcome in UK practice . A systematic approach to optimize Hb mass before arthroplasty and limit Hb loss perioperatively was associated with improved outcome up to 90 days after discharge BACKGROUND Benchmarking transfusion activity may help to eliminate inappropriate use of blood products . The goal of this study was to measure and to compare the current transfusion  practice and to identify predictors of transfusion in public hospitals to develop strategies to optimize transfusion practice s. STUDY DESIGN AND METHODS This was a prospect i ve observational study in 18 r and omly selected public hospitals from April 2004 to February 2005 . Primary outcome measures were the amount of intra- and postoperative blood components transfused and intercenter variability of transfusion rate . Secondary outcome measures were prevalence of preoperative anemia , calculated perioperative blood loss , and lowest measured perioperative hemoglobin ( Hb ) level . RESULTS Adult patients undergoing primary unilateral total hip replacement ( THR , n = 1401 ) , primary unilateral knee replacement ( TKR , n = 1296 ) , hemicolectomy ( HECOC , n = 148 ) , and coronary artery bypass graft ( CABG ) surgery ( n = 777 ) were enrolled . Due to the small number , data of HECOC patients were not fully analyzed . In the remaining procedures , there was a large intercenter variability in the percentage of patients who received transfusions : THR 16 to 85 percent , TKR 12 to 87 percent , and CABG 37 to 63 percent . In the patients who received transfusions , the number of red blood cells ( RBC ) units transfused varied significantly . There was also a considerable intercenter variability in RBC loss . The prevalence of preoperative anemia was 19 percent and identical in both sexes . The incidence of preoperative anemia was three times higher in patients who received transfusions compared to those who did not . CONCLUSION This study demonstrates a high intercenter variability in RBC transfusions and RBC loss in st and ard surgical procedures . Whereas the variability in blood loss remains largely unexplained , the main predictors for allogeneic RBC transfusions are preoperative and nadir Hb and surgical RBC loss This prospect i ve r and omised clinical trial evaluated the effect of alternatives for allogeneic blood transfusions  after total hip replacement and total knee replacement in patients with pre-operative haemoglobin levels between 10.0 g/dl and 13.0 g/dl . A total of 100 patients were r and omly allocated to the Eprex ( pre-operative injections of epoetin ) or Bellovac groups ( post-operative retransfusion of shed blood ) . Allogeneic blood transfusions were administered according to hospital policy . In the Eprex group , 4 % of the patients ( two patients ) received at least one allogeneic blood transfusion . In the Bellovac group , where a mean 216 ml ( 0 to 700 ) shed blood was retransfused , 28 % ( 14 patients ) required the allogeneic transfusion ( p = 0.002 ) . When comparing Eprex with Bellovac in total hip replacement , the percentages were 7 % ( two of 30 patients ) and 30 % ( nine of 30 patients ) ( p = 0.047 ) respectively , whereas in total knee replacement , the percentages were 0 % ( 0 of 20 patients ) and 25 % ( five of 20 patients ) respectively ( p = 0.042 ) . Pre-operative epoetin injections  are more effective but more costly in reducing the need for allogeneic blood transfusions in mildly anaemic patients than post-operative retransfusion of autologous blood BACKGROUND The purpose of this study was to assess current practice s in blood management in elective orthopedic surgery in Europe . STUDY DESIGN AND METHODS For this 225-center prospect i ve survey , data were collected on 3996 patients .  Actual perioperative blood loss was compared to preoperative estimates . Differences in Hb levels and other outcome variables for patients receiving allogeneic versus autologous transfusions  were evaluated . The probability of allogeneic transfusion  based on selected predictor variables was estimated . RESULTS A total of 2640 ( 67 % ) hip and 1305 ( 33 % ) knee arthroplasty patients were evaluated .  Estimated blood loss ( median , 750 mL ) was significantly lower than computed blood loss ( median , 1944 mL ) . A total of 2762 ( 69 % ) patients received  transfusions  , including 1393 ( 35 % ) autologous-only and 1024 ( 25 % ) allogeneic-only . The probability of allogeneic transfusion  decreased with increasing baseline Hb , but differentially so for men and women . Transfusion triggers were Hb levels of 8.93 + /- 1.83 g per dL for allogeneic transfusions , and 21 percent of these occurred when the Hb level was greater than 10 g per dL. Autologous blood transfusion was associated with a significantly lower rate ( 1 % ) of wound infections than allogeneic blood transfusion ( 4.2 % ) . CONCLUSION Accurate assessment of preoperative Hb levels , better estimation of perioperative blood loss , efficient use of autologous blood , adherence to transfusion guidelines , and pharmacologic alternatives contribute to effective and comprehensive blood and anemia management Objective Epoietin ( EPO ) effectively decreases perioperative blood transfusion requirements . We evaluated the feasibility of using EPO beta to increase haemoglobin levels before total hip replacement ( THR ) and reduce transfusion . Material s and methods One hundred and seventy-one patients undergoing primary THR were included in this prospect i ve observational study . Patients with initial haemoglobin level < 130 g l−1  received EPO beta subcutaneously in a four-dose regimen . Haemoglobin levels were measured at baseline , before surgery , and at postoperative days 1 and 5 . Results Twenty-eight patients received EPO beta preoperatively , 143 were not treated including 42 with initial haemoglobin level < 130 g l−1 . Haemoglobin increased by 29 ± 9 g l−1 in the low Hb + EPO group versus 2 ± 1 g l−1 for the other patients . In the low Hb + EPO group 3.6 % were transfused , in the low HB group 45.2 % ( P = 0.001 ) and in the normal Hb group 11.9 % ( P = 0.2 ) . Conclusions Preoperative EPO beta  increases haemoglobin level and reduces transfusion frequency in anaemic patients before total joint replacement . It could play a major role in the management of perioperative blood loss in orthopaedic surgery A limitation of preoperative autologous blood donation ( PABD ) in nonanemics and the use of recombinant human erythropoietin ( EPO ) in anemics ( baseline hematocrit [ Hct ] ≤ 39 % ) could be an efficient approach of the cost-benefit ratio of transfusion during primary total hip ( THA ) or knee ( TKA ) arthroplasties . We evaluated the consequences on transfusion rates and costs of two different applications of a transfusion policy based on personal requirements during primary THA or TKA . This quality assuranceobservational study comparedtwo prospect i ve successive time periods ; each included successive patients treated by the same medical team and st and ardized care . In Study 1 ( n = 182 )  , PABD  was indicated if there were insufficient estimated red blood cell reserve and a life expectancy ≥10 yr , no use of EPO  , and identical criteria for any transfusion . Because this policy led to a 50 % allogeneic transfusion rate when baseline Hct ≤37 % and autologous blood wastage in the nonanemics ( baseline Hct > 39 % ) , 2 refinements were introduced in Study 2 ( n = 708):EPOwithoutPABDwhenbaselineHct≤37 % , and life expectancy ≥10 yr , and avoidance of PABD in nonanemics . This novel care induced a marked decrease in transfusion rates ( respectively , from 41 % to 7 % , P < 0.0002 , in nonanemics ; from 58 % to 27 % , P < 0.003 , in anemics ; and from 43 % to 12 % , P < 0.0001 , overall ) , with no change in allogeneic transfusion ( 10 % ) and discharge Hct , and a 39 % financial savings . This saving effect is a result of the suppression of PABD in nonanemics , who represent 75 % of this surgical population . Although erythropoietin is expensive , it can be used with cost savings in selected patients because the overall cost of transfusion is reduced Background and objective : Preoperative epoetin alfa administration decreases transfusion requirements and may reduce transfusion complications , such as postoperative infection due to immune suppression and thus hospitalization time . This study examined the impact of preoperative epoetin alfa administration on postoperative recovery and infection rate . Methods : In an open r and omized controlled multicentre trial in patients undergoing orthopaedic surgery , the effects of preoperative administration of epoetin alfa vs. routine care were compared in six countries . Haemoglobin ( Hb ) values , transfusions , time to ambulation , time to discharge , infections and safety were evaluated in patients with preoperative Hb concentrations 10‐13 g dL−1 ( on‐treatment population : epoetin n = 460 ; control n = 235 ) , from study entry until 4‐6 weeks after surgery . Outcome was also compared in patients with and without transfusion . Results : Epoetin‐treated patients had higher Hb values from the day of surgery until discharge ( P < 0.001 ) and lower transfusion rates ( 12 % vs. 46 % ; P < 0.001 ) . Epoetin treatment delivered no significant effect on postoperative recovery ( time to ambulation , time to discharge and infection rate ) . However , the time to ambulation ( 3.8 ± 4.0 vs. 3.1 ± 2.2 days ; P < 0.001 ) and the time to discharge ( 12.9 ± 6.4 vs. 10.2 ± 5.0 days ; P < 0.001 ) was longer in the transfused than in the non‐transfused patients . Side‐effects in both groups were comparable . Conclusions : Epoetin alfa  increases perioperative Hb concentration in mild‐to‐moderately anaemic patients and thus reduces transfusion requirements . Patients receiving blood transfusions require a longer hospitalization than non‐transfused patients BACKGROUND Previous studies on patients with hip fractures and in patients with colorectal cancer have documented that perioperative transfusion is associated with a significant increase in postoperative infection rate . Therefore , we sought to investigate the incidence of preoperative and postoperative anemia in noncardiac surgical patients and to determine if transfusion is an independent risk factor for infection and adverse outcome postoperatively . METHODS Prospect i ve data from the National Veterans Administration Surgical Quality Improvement Program ( NSQIP ) was collected on 6301 noncardiac surgical patients at the Veterans Affairs Maryl and Healthcare System from 1995 to 2000 . RESULTS The mean age of the study cohort was 61 + /- 13 . Descriptive data revealed 95 % were male , 44 % used tobacco , 19 % were diabetic , 9 % had COPD , 9 % used alcohol , 3 % used steroids , 
    Output:
    
Conclusions The findings overwhelmingly support preoperative optimisation of anaemia .