Increased severity of anaemia is associated with 30-day complications following total joint replacement

Gu, Alex; Malahias, Michael‐Alexander; Selemon, Nicolas A.; Wei, Chapman; Gerhard, Eleanor F.; Cohen, Jordan S.; Fassihi, Safa C.; Stake, Seth; Bernstein, Sophie L.; Chen, Aaron Z.; Sculco, Thomas P.; Cross, Michael B.; Liu, Jiabin; Ast, Michael P.; Sculco, Peter K.

doi:10.1302/0301-620x.102b4.bjj-2018-0991.r3

Cited by 52 publications

(37 citation statements)

References 14 publications

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“…These findings are consistent with other studies examining anemia in knee and hip arthroplasty. 10 , 19 …”

Section: Discussionmentioning

confidence: 99%

“… 3 , 5 , 15 , 17 All primary TSA procedures recorded between 2015 and 2018 were identified using Current Procedure Terminology code 23472. Based on similar categorical values used in other studies, 10 , 14 patients were stratified into 1 of 3 cohorts depending on their preoperative hematocrit (HCT) levels. Patients with greater than 38% preoperative HCT were classified as having normal HCT levels.…”

Section: Methodsmentioning

confidence: 99%

“… 18 Anemia is a relatively common condition among patients undergoing elective orthopedic surgery with studies reporting a prevalence between 21% and 35%. 2 , 9 Anemia has also been found to be a significant risk factor for postoperative complications in total knee and hip arthroplasty, 5 , 10 but the impact of severity of anemia on outcomes of patients undergoing TSA has not been defined. Given the profound growth in the volume of TSA procedures performed in the United States, we sought to investigate the potential link between anemia severity and patient outcomes after surgery.…”

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confidence: 99%

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Increasing severity of anemia is associated with poorer 30-day outcomes for total shoulder arthroplasty

et al. 2021

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Background Total shoulder arthroplasty (TSA) has increased in utilization over the past several decades. Anemia is a common preoperative condition among patients undergoing TSA and has been associated with poorer outcomes in other surgical procedures. To the best of our knowledge, no study has analyzed the association between anemia severity and TSA outcomes. Therefore, the purpose of this study is to determine the effects that increasing severity of anemia may have on the postoperative outcomes in patients receiving primary TSA. Methods A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from the years 2015 to 2018. Current Procedure Terminology code 23472 was used to identify all primary TSA procedures recorded during this time frame. Patients with greater than 38% preoperative hematocrit (HCT) were classified as having normal HCT levels. Patients with HCT values between 33% and 38% were classified as having mild anemia. All patients with less than 33% HCT were classified as having moderate/severe anemia. Patient demographic information, preoperative risk factors, and postoperative outcomes were compared among the 3 cohorts. A multivariate logistic regression including demographic factors and comorbidities was performed to determine whether increasing severity of anemia is independently associated with poorer postoperative outcomes. Results Of the 15,185 patients included in this study, 11,404 had normal HCT levels, 2962 patients were mildly anemic, and 819 patients had moderate to severe anemia. With increasing severity of anemia, there was an increased average hospital length of stay (1.6 vs. 2.1 vs. 3.0 days, P < .001), rate of readmissions (2.3% vs. 4.8% vs. 7.0%, P < .001), and rate of all reoperations (1.1% vs. 1.8% vs. 3.1%, P < .001). There was a statistically significant increase in both minor (1.9% vs. 2.7% vs. 4.4%, P < .001) and major (1.2% vs. 2.4% vs. 4.3%, P < .001) postoperative complication rates as well. Multivariate analysis identified anemia as an independent predictor of readmissions, reoperations, minor complications, and major complications. Conclusion We found increasing severity of anemia to be associated with progressively worse 30-day postoperative outcomes. This is consistent with the outcomes found for increasing severity of anemia in patients receiving other total joint procedures. Using preoperative HCT levels may be a useful tool for predicting the risk of postoperative complications in patients undergoing TSA. This information could be used to further optimize patient selection for primary TSA.

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“…These findings are consistent with other studies examining anemia in knee and hip arthroplasty. 10 , 19 …”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Increasing severity of anemia is associated with poorer 30-day outcomes for total shoulder arthroplasty

et al. 2021

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“…Previous studies performed on THA patients, 52 , 53 and on combined arthroplasty patients, 54 have demonstrated increased odds of postoperative complications, mortality, and surgical site infection in patients with preoperative anaemia. While our study similarly found increased odds of readmission in the TKA population with low HCT, these results were not seen in the THA cohort after adjustment for relevant covariates.…”

Section: Discussionmentioning

confidence: 93%

The association of preoperative blood markers with postoperative readmissions following arthroplasty

et al. 2021

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Aims While preoperative bloodwork is routinely ordered, its value in determining which patients are at risk of postoperative readmission following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is unclear. The objective of this study was to determine which routinely ordered preoperative blood markers have the strongest association with acute hospital readmission for patients undergoing elective TKA and THA. Methods Two population-based retrospective cohorts were assembled for all adult primary elective TKA (n = 137,969) and THA (n = 78,532) patients between 2011 to 2018 across 678 North American hospitals using the American College of Surgeons National Quality Improvement Programme (ACS-NSQIP) registry. Six routinely ordered preoperative blood markers - albumin, haematocrit, platelet count, white blood cell count (WBC), estimated glomerular filtration rate (eGFR), and sodium level - were queried. The association between preoperative blood marker values and all-cause readmission within 30 days of surgery was compared using univariable analysis and multivariable logistic regression adjusted for relevant patient and treatment factors. Results The mean TKA age was 66.6 years (SD 9.6) with 62% being females (n = 85,163/137,969), while in the THA cohort the mean age was 64.7 years (SD 11.4) with 54% being female (n = 42,637/78,532). In both cohorts, preoperative hypoalbuminemia (< 35 g/l) was associated with a 1.5- and 1.8-times increased odds of 30-day readmission following TKA and THA, respectively. In TKA patients, decreased eGFR demonstrated the strongest association with acute readmission with a standardized odds ratio of 0.75 per two standard deviations increase (p < 0.0001). Conclusion In this population level cohort analysis of arthroplasty patients, low albumin demonstrated the strongest association with acute readmission in comparison to five other commonly ordered preoperative blood markers. Identification and optimization of preoperative hypoalbuminemia could help healthcare providers recognize and address at-risk patients undergoing TKA and THA. This is the most comprehensive and rigorous examination of the association between preoperative blood markers and readmission for TKA and THA patients to date. Cite this article: Bone Jt Open 2021;2(6):388–396.

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“…By comparison, PMSA was usually difficult to resolve, needing further treatments, such as intravenous iron, erythropoietin, even transfusion [ 17 , 18 ]. Moreover, patients who developed PMSA had higher risk of developing postoperative complications relative to patients with mild anemia following joint replacement [ 19 ]. Thus, we selected PMSA as the outcome variable, evaluating related risk factor and attempting to decrease the rate.…”

Section: Discussionmentioning

confidence: 99%

Association between preoperative hemoglobin and postoperative moderate and severe anemia among patients undergoing primary total knee arthroplasty: a single-center retrospective study

Cao

Yang

et al. 2021

J Orthop Surg Res

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Background Postoperative moderate and severe anemia (PMSA) has been a serious perioperative complication in primary total knee arthroplasty (TKA). However, the ideal cutoff values to predict PMSA is still undetermined. The aim of this study was (1) to identify the risk factors associated with PMSA and (2) to establish the cutoff values of preoperative hemoglobin (HB) associated with increased PMSA in primary TKA. Methods We identified 474 patients undergoing primary TKA and separated those in which PMSA (HB was less than 110 g/L on postoperative day 1 and 3) was developed from those without PMSA. Multivariate logistic regression model was used to identify independent risk factors for PMSA. Area under the receiver-operator curve (AUC) was used to determine the best-supported preoperative HB cutoff across all the patients. Results The PMSA rate in primary TKA was 53.2%. Significant risk factors were lower preoperative HB (OR [odds ratio] = 1.138, 95% CI [confidence interval] = 1.107–1.170, p < 0.001) and more intraoperative blood loss (OR = 1.022, 95% CI 1.484–4.598, p < 0.001). A preoperative HB cutoff value that maximized the AUC was 138.5 g/L for men (sensitivity: 79.4%, specificity: 75.0%) and 131.5 g/L for women (sensitivity: 74.7%, specificity: 80.5%), respectively. Conclusion We should recognize and consider the related risk factors to establish specific, personalized risk assessment for PMSA, including preoperative HB and intraoperative blood loss. Of these, preoperative HB was a referable tool to predict PMSA in primary TKA.

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Increased severity of anaemia is associated with 30-day complications following total joint replacement

Cited by 52 publications

References 14 publications

Increasing severity of anemia is associated with poorer 30-day outcomes for total shoulder arthroplasty

Increasing severity of anemia is associated with poorer 30-day outcomes for total shoulder arthroplasty

The association of preoperative blood markers with postoperative readmissions following arthroplasty

Association between preoperative hemoglobin and postoperative moderate and severe anemia among patients undergoing primary total knee arthroplasty: a single-center retrospective study

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