Association between Allogeneic Blood Transfusion and Wound Infection after Total Hip or Knee Arthroplasty: A Retrospective Case-Control Study

Taneja, Ashish; El‐Bakoury, Ahmed; Khong, Hoa; Railton, P.; Sharma, Rajrishi; Johnston, Kelly; Puloski, Shannon; Smith, Christopher; Powell, James

doi:10.7150/jbji.30636

Cited by 31 publications

(27 citation statements)

References 36 publications

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“…Allogeneic blood transfusion is associated with an increased risk of surgical site infection and PJI. [ 6 - 8 ] This has been hypothesized to be related to the immunomodulatory effects of transfusion. The results of our study confirm this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“…Tranexamic acid (TA) is a synthetic antifibrinolytic substance that inhibits proteolytic degradation of fibrin by blocking the lysine binding sites of allogenic blood transfusion causes alteration in immune system which can result in higher risk of surgical site infection. [6][7][8] Thus TA may reduce the rate of early and delayed PJI. In this study, we aimed to analyze the effect of intravenous administration of TA on reducing the risk of revision for acute and delayed PJI after primary TKR.…”

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confidence: 99%

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Tranexamic acid decreases the risk of revision for acute and delayed periprosthetic joint infection after total knee replacement

et al. 2020

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This study aims to analyze the effect of intravenous administration of tranexamic acid (TA) on reducing the risk of revision for acute and delayed periprosthetic joint infection (PJI) after primary total knee replacement (TKR). Patients and methods: This prospective observational cohort study included 1,529 TKRs (396 males, 1,133 females; mean age 67.8 years; range, 44 to 85.1 years) performed between January 2003 and October 2017. We analyzed the revision rate for acute and delayed PJI in a group of 787 TKRs with preoperatively intravenously administered TA (TA group) in comparison with a group of 742 TKRs without administration of TA (non-TA group). Multiple logistic regression analysis was used to evaluate significant predictors of TKR revision for acute and delayed PJI. Results: Revision surgery due to PJI was recorded in one patient in the TA group and eight patients in the non-TA group. Cumulative revision rate of TKR was significantly lower in the TA group (0.13% vs. 1.08%, hazard ratio 0.113; 95% confidence interval [CI] 0.0147-0.937; p=0.043). Multivariate logistic regression analysis confirmed two predictors of revision: being aged over 75 years at the time of primary surgery (odds ratio [OR] 8.464; 95% CI: 2.016-35.54; p=0.004) and male gender (OR: 7.9; 95% CI: 1.879-33.26; p=0.005). The use of TA was shown as the significant protective factor (OR: 0.109; 95% CI: 0.0128-0.929; p=0.043). Conclusion: We have found a lower cumulative revision rate of TKR for acute and delayed PJI when TA was used. We think that the preoperative intravenous use of TA may be an effective, safe and inexpensive method for the prevention of PJI.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Tranexamic acid decreases the risk of revision for acute and delayed periprosthetic joint infection after total knee replacement

et al. 2020

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“…Our study also found higher rates of transfusion rates in the DDH cohort. This is concerning as higher allogeneic blood transfusion after arthroplasty have been associated with higher odds of mortality and increased superficial and deep wound infections [23,24].…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty for Developmental Dysplasia of Hip vs Osteoarthritis: A Propensity Matched Pair Analysis

et al. 2020

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Background: The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program to compare the perioperative and postoperative outcomes after total hip arthroplasty (THA) for DDH and primary OA via a propensity-matched pair analysis and the valuation of THA between both groups. Material and Methods: All patients who underwent THA between 2008 and 2016 were identified from National Surgical Quality Improvement Program database via the current procedural terminology (CPT) code. Patients were further identified and stratified based on International Statistical Classification of Diseases and Related Health Problemse9/International Statistical Classification of Diseases and Related Health Problemse10 diagnosis codes for primary OA (n ¼ 115,166) and DDH (n ¼ 603), which included codes for congenital hip dislocation, hip dysplasia, or juvenile osteochondrosis. Demographic variables were used to create 557 propensity-matched pairs. Results: The DDH group was associated with a significantly longer operative time (120.3 vs 95.9 min), higher postoperative transfusion rate (12% vs 6.6%), and longer hospital length of stay (2.8 vs 2.5 days) compared with the primary OA group (P < .001, P < .001, and P ¼ .002, respectively). There were no statistically significant differences found between the two groups with respect to inpatient complications, discharge disposition (P ¼ .123), readmissions (P ¼ .615), or reoperations (P ¼ .404). Conclusions: Health policy makers should be cognizant of the higher complexity of THA for DDH when determining whether DDH and primary OA should be in the same bundle. Owing to the limitations of our data set, all the observed associations are likely an underestimate of the true risk posed to patients with severe DDH, as these patients were unable to be stratified in the present analysis.

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“… 66 A more recent retrospective case control study involving more than 27,000 patients undergoing primary THA and TKA demonstrated an overall incidence of blood transfusion of 11.1%, which was associated with a significantly increased risk of superficial infection (adjusted odds ratio [ OR ] 1.9 [95% CI 1.2–2.9, p-value 0.005]) as well as deep infection (adjusted OR 1.6 [95% CI 1.1–2.2, p-value 0.008]). 67 A study involving 2760 patients undergoing primary hip and knee arthroplasty procedures in Germany, showed that the overall complication rate in patients who received transfusions was 34.7% compared with 13.2% in patients who did not require transfusion, with infection rates of 2.82% and 0.4% respectively. 68 …”

Section: Blood Transfusionmentioning

confidence: 99%

Prevention of infection in primary THA and TKA

Dobson

Reed

2020

EFORT Open Reviews

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Rates of peri-prosthetic joint infection (PJI) in primary total hip and total knee arthroplasty range between 0.3% and 1.9%, and up to 10% in revision cases. Significant morbidity is associated with this devastating complication, the economic burden on our healthcare system is considerable, and the personal cost to the affected patient is immeasurable. The risk of surgical site infection (SSI) and PJI is related to surgical factors and patient factors such as age, body mass index (BMI), co-morbidities, and lifestyle. Reducing the risk of SSI in primary hip and knee arthroplasty requires a multi-faceted strategy including pre-operative patient bacterial decolonization, screening and avoidance of anaemia, peri-operative patient warming, skin antisepsis, povidone-iodine wound lavage, and anti-bacterial coated sutures. This article also considers newer concepts such as the influence of bearing surfaces on infection risk, as well as current controversies such as the potential effects of blood transfusion, laminar flow, and protective hoods and suits, on infection risk. Cite this article: EFORT Open Rev 2020;5:604-613. DOI: 10.1302/2058-5241.5.200004

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Association between Allogeneic Blood Transfusion and Wound Infection after Total Hip or Knee Arthroplasty: A Retrospective Case-Control Study

Cited by 31 publications

References 36 publications

Tranexamic acid decreases the risk of revision for acute and delayed periprosthetic joint infection after total knee replacement

Tranexamic acid decreases the risk of revision for acute and delayed periprosthetic joint infection after total knee replacement

Total Hip Arthroplasty for Developmental Dysplasia of Hip vs Osteoarthritis: A Propensity Matched Pair Analysis

Prevention of infection in primary THA and TKA

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