Advances in perioperative patient blood management with enhanced recovery in orthopedics: current situation and future prospects

Blood is the essence of life and plays a crucial role in ensuring the normal functioning of organs. During orthopedic surgery, a large volume of blood loss is inevitable; moreover, it is worse in surgeries after traumas, which could affect the function of vital organs and increase the incidence of serious complications and postoperative mortality. Perioperative patient blood management is one of the key components and a prerequisite for enhanced recovery after orthopedic surgery. Multidisciplinary cooperation is needed to examine the key technique of perioperative patient blood management and thus promote the development of enhanced recovery programs in orthopedics. The key techniques of perioperative patient blood management in orthopedics included the following: (1) strengthening the diagnosis and treatment of preoperative anemia, increasing the hemoglobin level, and establishing self-blood banks for patients, which are the basis for reducing blood transfusion to achieve “Kai Yuan” of patient blood management, (2) adopting advanced comprehensive measures, particularly research and application of antifibrinolytic drug tranexamic acid to reduce intraoperative and postoperative bleeding and blood transfusion, thus achieve the “Jie Liu” of patient blood management, (3) reducing postoperative bleeding, treating postoperative anemia, and keeping the balance between fibrinolysis and coagulation to reduce blood loss and occurrence of deep venous thrombosis, and (4) establishing transfusion evaluation mechanism in elective orthopedic surgery. Thus, perioperative patient blood management in enhanced recovery after orthopedic surgery will gradually reduce complications caused by bleeding, fibrinolysis, and coagulation. Moreover, it will eventually achieve the goal of less or no blood transfusion surgery and accelerated rehabilitation and promote further development of the hospital.