Location
Philadelphia, PA
Start Date
10-5-2021 12:00 AM
End Date
13-5-2021 12:00 AM
Description
Background: Perioperative allogenic blood transfusions (ABT) have demonstrated associations with poor outcomes and increased complication rates following total joint arthroplasty (TJA). Recent strides in blood conservation methods have been made, including multimodal blood management, tranexamic acid (TXA) use, and restrictive transfusion strategies in order to reduce risk associated with transfusion. While the literature on transfusions and outcomes is extensive, the consequences of low postoperative hemoglobin is less well defined. This study aimed to identify factors and consequences associated with severe anemia (hemoglobin <8g/dL) following primary TJA.
Methods: A retrospective review was conducted of all the elective primary TJA at a single tertiary care medical center from January 2017 to December 2018. One thousand six hundred and thirty-five cases were stratified based on the development of severe postoperative anemia, and compared based on patient preoperative hemoglobin, comorbidities, demographics, intraoperative variables, and postoperative outcomes. Logistic regression was used to identify independent predictors of severe postoperative anemia.
Results: Surgical duration (per 30 minute increase) (OR, 2.03; 95% CI, 1.59-2.58), preoperative hemoglobin (per 1g/dL decrease) (odds ratio [OR], 2.96; 95% confidence interval [CI], 2.38-6.38), and THA vs. TKA (OR, 2.06; 95% CI 1.26-3.37) were independently associated with severe postoperative anemia. Use of TXA (OR, 0.42; 0.20-0.85), and body mass index (per 1kg/m2 increase) (OR, 0.90; 95% CI, 0.86-0.95) were protective against it. Severe postoperative anemia was associated with acute kidney injury (AKI), longer length of stay (LOS), and 90-day emergency department visits/readmissions.
Conclusions: Longer duration of surgery, lower preoperative hemoglobin, and THA are all associated with severe postoperative anemia, and lead to complications of AKI, increased LOS, and higher readmission rates. As the incidence of fast-track TJA and outpatient surgery steadily increase, reducing the extent of postoperative anemia is essential for patient outcomes.
Embargo Period
6-4-2021
Predictive Factors and Outcomes in Patients With Severe Postoperative Anemia Following Total Joint Arthroplasty
Philadelphia, PA
Background: Perioperative allogenic blood transfusions (ABT) have demonstrated associations with poor outcomes and increased complication rates following total joint arthroplasty (TJA). Recent strides in blood conservation methods have been made, including multimodal blood management, tranexamic acid (TXA) use, and restrictive transfusion strategies in order to reduce risk associated with transfusion. While the literature on transfusions and outcomes is extensive, the consequences of low postoperative hemoglobin is less well defined. This study aimed to identify factors and consequences associated with severe anemia (hemoglobin <8g/dL) following primary TJA.
Methods: A retrospective review was conducted of all the elective primary TJA at a single tertiary care medical center from January 2017 to December 2018. One thousand six hundred and thirty-five cases were stratified based on the development of severe postoperative anemia, and compared based on patient preoperative hemoglobin, comorbidities, demographics, intraoperative variables, and postoperative outcomes. Logistic regression was used to identify independent predictors of severe postoperative anemia.
Results: Surgical duration (per 30 minute increase) (OR, 2.03; 95% CI, 1.59-2.58), preoperative hemoglobin (per 1g/dL decrease) (odds ratio [OR], 2.96; 95% confidence interval [CI], 2.38-6.38), and THA vs. TKA (OR, 2.06; 95% CI 1.26-3.37) were independently associated with severe postoperative anemia. Use of TXA (OR, 0.42; 0.20-0.85), and body mass index (per 1kg/m2 increase) (OR, 0.90; 95% CI, 0.86-0.95) were protective against it. Severe postoperative anemia was associated with acute kidney injury (AKI), longer length of stay (LOS), and 90-day emergency department visits/readmissions.
Conclusions: Longer duration of surgery, lower preoperative hemoglobin, and THA are all associated with severe postoperative anemia, and lead to complications of AKI, increased LOS, and higher readmission rates. As the incidence of fast-track TJA and outpatient surgery steadily increase, reducing the extent of postoperative anemia is essential for patient outcomes.
Comments
Winner of 2021 Research Week CCDA Resident Award