Identification of the haemoglobin level associated with a lower risk of complications after total hip and knee arthroplasty

Abstract

Background: Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut-off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established.Methods: Planned secondary analysis of data collected during a multicentre cohort study of patients undergoing THA and TKA in 131 Spanish hospitals during a single 2-month recruitment period. Anaemia was defined as haemoglobin <12 g dl À1 for females and < 13 g dl À1 for males. The primary outcome was the number of patients with 30-day in-hospital postoperative complications according to European Perioperative Clinical Outcome definitions and specific surgical TKA and THA complications.Secondary outcomes included the number of patients with 30-day moderate-tosevere complications, red blood cell transfusion, mortality, and length of hospital stay.Binary logistic regression models were constructed to assess association between preoperative Hb concentrations and postoperative complications, and variables significantly associated with the outcome were included in the multivariate model. The study sample was divided into 11 groups based on preoperative Hb values in an effort to identify the threshold at which increased postoperative complications occurred.Results: A total of 6099 patients were included in the analysis (3818 THA and 2281 TKA), of whom 8.8% were anaemic. Patients with preoperative anaemia were more likely to suffer overall complications (111/539, 20.6% vs. 563/5560, 10.1%, p < .001) and moderate-to-severe complications (67/539, 12.4% vs. 284/5560, 5.1%, p < .001). Multivariable analysis showed preoperative haemoglobin ≥14 g dl À1 was associated with fewer postoperative complications. Conclusion:Preoperative haemoglobin ≥14 g dl À1 is associated with a lower risk of postoperative complications in patients undergoing primary TKA and THA.

Preoperative hemoglobin thresholds for increased risk of “medical” complications in fast‐track total hip and knee arthroplasty, a secondary analysis of a machine‐learning algorithm

“…Our analysis demonstrates that within our machine‐learning risk‐model, the preoperative Hb threshold for an increased risk of prolonged length of stay or readmissions due to medical issues was 14.8 g/dL in both men and women. This is similar as a recent study in about 7000 THA and TKAs (only 25% within fast‐track/ERAS programs) which reported fewer postoperative complications with a Hb >14.0 g/dL 7 . Thus, the results of both studies support removing the gender‐specific Hb criteria for preoperative anemia in elective THA and TKA.…”

“…This is similar as a recent study in about 7000 THA and TKAs (only 25% within fast-track/ERAS programs) which reported fewer postoperative complications with a Hb >14.0 g/dL. 7 Thus, the results of both studies support removing the gender-specific Hb criteria for preoperative anemia in elective THA and TKA. Furthermore, the influence of a preoperative Hb level <14.8 g/dL appeared largely age-independent, supporting that the gender differences should be removed regardless of patient age.…”

Does diabetes mellitus impair the clinical results of total knee arthroplasty under enhanced recovery after surgery?

“…Blood management is an important part of ERAS [ 16 ], higher preoperative hemoglobin level in a certain range is related to the reduction of complications after TKA, Cai and his group found that the LOS decreased with increased hemoglobin values when Preoperative Hemoglobin was beyond 140 g/L [ 27 ]. Further studies show that preoperative hemoglobin ≥ 140 g/L is associated with a lower risk of postoperative complications in patients undergoing primary TKA [ 28 ]. Li and his co-worker found that preoperative anemic patients had higher rates of complications, extended LOS, and mortalities [ 29 ], and preoperative anemia also affected the postoperative blood transfusion rate [ 30 ].…”