Leiden Implementation Study of Blood management in hip and knee Arthroplasties

This study is recruiting.


Despite the availability of evidence that the blood saving measures erythropoietin (EPO) and perioperative autologous blood salvage (in short: blood salvage) are not cost-effective in elective primary hip- and knee arthroplasties, over 85% of the Dutch orthopaedic departments still use one of these techniques. In a problem analysis study a tailored intervention is developed to de-implement EPO and blood salvage in elective primary total hip- and knee arthroplasties.


To assess the effectiveness, feasibility and costs of this tailored de-implementation intervention. The hypothesis is that the intervention results in an absolute decrease of 20% in patients receiving EPO or blood salvage in comparison to usual care (control strategy).

Study design

The design is a hospital-clustered RCT comparing the tailored de-implementation intervention with passive dissemination of evidence in 20 hospitals.


The intervention hospitals receive a tailored intervention geared at barriers and facilitators to de-implement BSMs that includes educational activities and feedback. The control hospitals receive the evidence about BSMs and their (cost) effectiveness in a passive manner. There are two scheduled visits in the intervention group. One visit takes place at the start of the intervention for an interactive education and one visit during the intervention to give feedback. Professionals will receive electronic newsletters during the intervention.

Study population

The intervention is aimed at orthopaedic surgeons and anaesthesiologists in 20 hospitals. Chart review will be performed of at least 50 patients receiving a primary elective hip- or knee arthroplasty per hospital.

Main study endpoints and parameters

Primary outcome measure

  • Number of patients receiving EPO and blood salvage.

Secondary outcome measure

  • Patient outcomes (allogenic transfusions, transfusion reactions, complications, length of stay), feasibility, costs.

Research staff 

  • Prof A Brand MD PhD
  • Prof RGHH Nelissen MD PhD
  • C So-Osman MD PhD