Predictors and Outcomes of Postoperative Hemoglobin of <8 g/dL in Total Joint Arthroplasty.
BACKGROUND: Restrictive transfusion practices have decreased transfusions in total joint arthroplasty (TJA). A hemoglobin threshold of/dL is commonly used. Predictors of this degree of postoperative anemia in TJA and its association with postoperative outcomes, independent of transfusions, remain unclear. We identified predictors of postoperative hemoglobin of/dL and outcomes with and without transfusion in TJA.
METHODS: Primary elective TJA cases performed with a multimodal blood management protocol from 2017 to 2018 were reviewed, identifying 1,583 cases. Preoperative and postoperative variables were compared between patients with postoperative hemoglobin of≥8 g/dL. Logistic regression and receiver operating characteristic curves were used to assess predictors of postoperative hemoglobin of/dL.
RESULTS: Positive predictors of postoperative hemoglobin of/dL were preoperative hemoglobin level (odds ratio [OR] per 1.0-g/dL decrease, 3.0 [95% confidence interval (CI), 2.4 to 3.7]), total hip arthroplasty (OR compared with total knee arthroplasty, 2.1 [95% CI, 1.3 to 3.4]), and operative time (OR per 30-minute increase, 2.0 [95% CI, 1.6 to 2.6]). Negative predictors of postoperative hemoglobin of/dL were tranexamic acid use (OR, 0.42 [95% CI, 0.20 to 0.85]) and body mass index (OR per 1 kg/m2 above normal, 0.90 [95% CI, 0.86 to 0.94]). Preoperative hemoglobin levels of
CONCLUSIONS: Postoperative hemoglobin of/dL after TJA was associated with worse outcomes, even for patients who do not receive transfusions. Optimizing preoperative hemoglobin levels may mitigate postoperative anemia and adverse outcomes.
LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery: American Volume
Chaudhry, Yash P; MacMahon, Aoife; Rao, Sandesh S; Mekkawy, Kevin L; Toci, Gregory R; Oni, Julius K; Sterling, Robert S; and Khanuja, Harpal S, "Predictors and Outcomes of Postoperative Hemoglobin of <8 g>/dL in Total Joint Arthroplasty." (2021). Orthopedic Surgery Resident Research. 55.