Location
Philadelphia, PA
Start Date
10-5-2021 12:00 AM
End Date
13-5-2021 12:00 AM
Description
Background: Surgery for prosthetic joint infection (PJI) can often have significant blood loss necessitating allogeneic blood transfusion (ABT). ABT is associated with higher rates of morbidity and death in revision TJA, particularly in the treatment of PJI. It is important to understand how the rates of ABT differ among the various surgical treatments of PJI. We compared ABT rates by procedure type among patients treated for PJI a multimodal blood conservation protocol.
Methods: We retrospectively reviewed 143 operative cases of revision arthroplasty for hip and knee PJI involving 102 patients at a single institution between 2016 and 2018. Procedures were categorized as 1. irrigation and debridement (I&D) with modular component exchange (“modular component exchange”), 2. explantation with I&D and placement of antibiotic spacer (“explantation”), 3. I&D with antibiotic spacer exchange (“spacer exchange”), or 4. antibiotic spacer removal and prosthetic reimplantation (“reimplantation”). ABT rates and number of units transfused were assessed for the four procedures. Factors associated with ABT were assessed with a multilevel mixed-effects regression model.
Results: Seventy-seven cases (54%) received ABT. The highest rates of ABT occurred during explantations (74%) and spacer exchanges (72%), followed by reimplantations (36%) and modular component exchanges (33%). After adjusting for perioperative variables, lower preoperative hemoglobin level was associated with higher odds of ABT (odds ratio [OR], 1.9 [per 1-g/dL decrease]; 95% confidence interval [CI]: 1.5–2.5). Explantation (OR, 14; 95% CI: 4.0–50), reimplantation (OR, 4.3; 95% CI: 1.1–16), and spacer exchanges (OR, 5.6; 95% CI: 1.1–28) were associated with greater odds of ABT. Antibiotic spacer exchanges (OR, 26; 95% CI: 2.1-315) and explantations (OR, 11; 95% CI: 2.1-61) were associated with greater odds of multiple unit transfusions.
Discussion: Despite a restrictive transfusion protocol, ABT rates remain high in the surgical treatment of PJI. Antibiotic spacer exchange and explantation procedures had high rates of multiple unit transfusions, and additional units of blood should be made available. Preoperative anemia should be treated when possible, and further refinement of blood management protocols in prosthetic joint infection is necessary.
Embargo Period
6-4-2021
Blood Transfusions in Revision Surgery for Prosthetic Hip and Knee Infection
Philadelphia, PA
Background: Surgery for prosthetic joint infection (PJI) can often have significant blood loss necessitating allogeneic blood transfusion (ABT). ABT is associated with higher rates of morbidity and death in revision TJA, particularly in the treatment of PJI. It is important to understand how the rates of ABT differ among the various surgical treatments of PJI. We compared ABT rates by procedure type among patients treated for PJI a multimodal blood conservation protocol.
Methods: We retrospectively reviewed 143 operative cases of revision arthroplasty for hip and knee PJI involving 102 patients at a single institution between 2016 and 2018. Procedures were categorized as 1. irrigation and debridement (I&D) with modular component exchange (“modular component exchange”), 2. explantation with I&D and placement of antibiotic spacer (“explantation”), 3. I&D with antibiotic spacer exchange (“spacer exchange”), or 4. antibiotic spacer removal and prosthetic reimplantation (“reimplantation”). ABT rates and number of units transfused were assessed for the four procedures. Factors associated with ABT were assessed with a multilevel mixed-effects regression model.
Results: Seventy-seven cases (54%) received ABT. The highest rates of ABT occurred during explantations (74%) and spacer exchanges (72%), followed by reimplantations (36%) and modular component exchanges (33%). After adjusting for perioperative variables, lower preoperative hemoglobin level was associated with higher odds of ABT (odds ratio [OR], 1.9 [per 1-g/dL decrease]; 95% confidence interval [CI]: 1.5–2.5). Explantation (OR, 14; 95% CI: 4.0–50), reimplantation (OR, 4.3; 95% CI: 1.1–16), and spacer exchanges (OR, 5.6; 95% CI: 1.1–28) were associated with greater odds of ABT. Antibiotic spacer exchanges (OR, 26; 95% CI: 2.1-315) and explantations (OR, 11; 95% CI: 2.1-61) were associated with greater odds of multiple unit transfusions.
Discussion: Despite a restrictive transfusion protocol, ABT rates remain high in the surgical treatment of PJI. Antibiotic spacer exchange and explantation procedures had high rates of multiple unit transfusions, and additional units of blood should be made available. Preoperative anemia should be treated when possible, and further refinement of blood management protocols in prosthetic joint infection is necessary.