Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty

Abstract

Background: The need for a transfusion is one of the adverse events following total knee arthroplasty (TKA), and accurately predicting this need remains challenging for arthroplasty surgeons. The purpose of the present research is to study the preoperative predictors of transfusion risk in patients following TKA and develop a nomogram. Methods: The nomogram was developed based on a training set of 5402 patients who underwent TKA at the Affiliated Hospital of Qingdao University between September 2013 and November 2018. The independent predictors of transfusion were identified by univariate, LASSO, and binary logistic regression analyses. Then, a nomogram was established based on these independent predictors. The area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were selected to evaluate the nomogram. The results were validated using an independent set of 1116 patients who underwent TKA between December 2018 and September 2019. In addition, we also carried out subgroup analyses in the training and testing sets based on the independent predictors. Results: Five independent predictors were identified by multivariate analysis and were used to establish the nomogram. The AUCs of the nomogram were 0.884 (95% CI: 0.865-0.903) and 0.839 (95% CI, 0.773-0.905) in the training and testing sets, respectively. In both the training and testing sets, the calibration curve indicated that the prediction by the nomogram was highly consistent with the actual observation, and the DCA indicated that the nomogram had a favorable level of clinical usefulness. In addition, the AUC of the nomogram was significantly higher than the AUC of any independent predictor for predicting transfusion risk following TKA, and the subgroup analysis showed good performance in 20 subgroups. Conclusion: Lower preoperative Hb levels, simultaneous bilateral TKA, lower BMI, older age, and coronary heart disease were identified as independent predictors of postoperative transfusion in patients following TKA. A nomogram incorporating the above five predictors could accurately predict the transfusion risk.

Establishment and Verification of a Perioperative Blood Transfusion Model After Posterior Lumbar Interbody Fusion: A Retrospective Study Based on Data From a Local Hospital

“…Yoshihara and Yoneoka (28) showed that middle-aged and elderly patients were more likely to receive allogeneic blood transfusions than middle-aged and young patients. Similarly, Hu et al (29) collected clinical data from more than 4,000 patients who underwent total knee arthroplasty in the Affiliated Hospital of Qingdao University and found that advanced age was an independent predictor of peri-operative blood transfusion. The older the patient's age is, the worse the hematopoietic function, and the greater the decreases in the lifespan and function of red blood cells.…”

Efficacy and Safety of Intravenous Ferric Carboxymaltose in Patients with Postoperative Anemia Following Same-Day Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial

“…In addition, it is burdensome and not always possible for patients who are scheduled for surgery to visit the hospital before surgery so that anemia can be identified and treated [ 8 ]. Furthermore, it is not possible to accurately predict which patients will develop postoperative anemia after TKA [ 9 ].…”

“…In addition, it is burdensome and not always possible for patients who are scheduled for surgery to visit the hospital before surgery so that anemia can be identified and treated [8]. Furthermore, it is not possible to accurately predict which patients will develop postoperative anemia after TKA [9]. Intravenous (IV) ferric carboxymaltose (FCM) is an innovative IV iron formulation and stable iron complex that consists of a ferric hydroxide core stabilized by a nondextran carbohydrate shell [10].…”

Effect of severity and cause of preoperative anemia on the transfusion rate after total knee arthroplasty

“…Jo et al 7 reported Hb level, type of surgery, use of TXA, platelet count, age, and body weight as risk factors for transfusion after TKA. Hu et al 8 also presented the Hb level, age, BMI, and coronary heart disease as risk factors. However, unlike previous studies that tried to develop a prediction model including different variables, this study minimized variables to Hb level and cardiac disease by excluding TXA non-users and evaluating predictors separately depending on the surgery type.…”

“…Preoperative Hb level is a well-known and potent risk factor for transfusion after TKA 6 – 8 . Several guidelines related to patient blood management (PBM) or enhanced recovery after surgery (ERAS) have recommended correction of anemia before TKA using iron or erythropoietin supplementation 9 – 12 .…”