• Blood transfusion;
  • Infection;
  • Orthopedic surgery;
  • Postoperative recovery;
  • Recombinant human erythropoietin


This trial compared the effect of preoperative administration of epoetin alfa (EPO) and best standard of care (BSC) on transfusion rate and its impact on postoperative recovery in a daily life setting. Hemoglobin (Hb) concentrations, transfusions, time to ambulation, hospitalization time, infections, and safety parameters were evaluated in orthopedic surgery patients with preoperative Hb values 10–13 g/dL from study entry until 4–6 weeks after surgery (on-treatment: 460 patients EPO, 235 BSC). Mean Hb values (not different at baseline) were higher in the EPO group than in the BSC group (p < 0.05) from the day of surgery until the end of the observation period. Transfusion rate was 12% in the EPO group vs. 46% in the BSC group (p < 0.05). No significant relation was detected between treatment and postoperative recovery (hospitalization time, time to ambulation, infection rate), probably due to the small number of transfused patients in the EPO group. Hospitalization time and time to ambulation were, however, longer in transfused than in nontransfused patients (p < 0.05). Postoperative infections occurred in 12.9% and 8.9% of transfused and nontransfused patients, respectively (NS). Side effects in both groups were comparable. We conclude that epoetin alfa significantly increases Hb in the perioperative period in mildly to moderately anemic patients, with a significant reduction of allogeneic blood transfusions. Patients exposed to allogeneic blood transfusion require a longer hospitalization. The number of transfusions in this study was too limited to confirm former observations on reduction of postoperative infections.