Iron Deficiency Anemia is Associated with Increased Early Postoperative Surgical and Medical Complications Following Total Hip Arthroplasty

Sequeira, Sean B.; Quinlan, Nicole D.; Althoff, Alyssa D.; Werner, Brian C.

doi:10.1016/j.arth.2020.09.043

Cited by 22 publications

(7 citation statements)

References 28 publications

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“…utilise the preoperative period as a 'window of opportunity') [29]. Such improvements should enhance patient safety (21.5% of our patients were anaemic [30] and 12.9% were morbidly obese with Body Mass Index (BMI) ≥ 40) [31]) and resource utilisation (10.1% of patients were cancelled/postponed prior to surgery). Further, in our setting with low literacy and limited ability to seek information, we are hopeful that a pragmatic approach to patient education would improve patient empowerment and participation in postoperative rehabilitation, as is standard practice in HICs [28].…”

Section: The Patient Characteristics and Standard Perioperative Practicementioning

confidence: 99%

Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

Plenge

Parker

Davids

et al. 2020

BMC Musculoskelet Disord

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Background Encouraged by the widespread adoption of enhanced recovery protocols (ERPs) for elective total hip and knee arthroplasty (THA/TKA) in high-income countries, our nationwide multidisciplinary research group first performed a Delphi study to establish the framework for a unified ERP for THA/TKA in South Africa. The objectives of this second phase of changing practice were to document quality of patient recovery, record patient characteristics and audit standard perioperative practice. Methods From May to December 2018, nine South African public hospitals conducted a 10-week prospective observational study of patients undergoing THA/TKA. The primary outcome was ‘days alive and at home up to 30 days after surgery’ (DAH30) as a patient-centred measure of quality of recovery incorporating early death, hospital length of stay (LOS), discharge destination and readmission during the first 30 days after surgery. Preoperative patient characteristics and perioperative care were documented to audit practice. Results Twenty-one (10.1%) out of 207 enrolled patients had their surgery cancelled or postponed resulting in 186 study patients. No fatalities were recorded, median LOS was 4 (inter-quartile-range (IQR), 3–5) days and 30-day readmission rate was 3.8%, leading to a median DAH30 of 26 (25–27) days. Forty patients (21.5%) had pre-existing anaemia and 24 (12.9%) were morbidly obese. In the preoperative period, standard care involved assessment in an optimisation clinic, multidisciplinary education and full-body antiseptic wash for 67 (36.2%), 74 (40.0%) and 55 (30.1%) patients, respectively. On the first postoperative day, out-of-bed mobilisation was achieved by 69 (38.1%) patients while multimodal analgesic regimens (paracetamol and Non-Steroid-Anti-Inflammatory-Drugs) were administered to 29 patients (16.0%). Conclusion Quality of recovery measured by a median DAH30 of 26 days justifies performance of THA/TKA in South African public hospitals. That said, perioperative practice, including optimisation of modifiable risk factors, lacked standardisation suggesting that quality of patient care and postoperative recovery may improve with implementation of ERP principles. Notwithstanding the limited resources available, we anticipate that a change of practice for THA/TKA is feasible if ‘buy-in’ from the involved multidisciplinary units is obtained in the next phase of our nationwide ERP initiative. Trial registration The study was registered with ClinicalTrials.gov (NCT03540667).

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Section: The Patient Characteristics and Standard Perioperative Practicementioning

confidence: 99%

Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

Plenge

Parker

Davids

et al. 2020

BMC Musculoskelet Disord

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“…Early PJI was associated with factors that promoted tissue hypoxia (smoking, heart failure, prolonged operative time, and hypertension) . Delayed PJI was associated with factors contributing to tissue hypoxia (prolonged operative time, general anesthesia, and anemia) and impaired wound healing and falls (morbid obesity and AUD) . Additional factors of late PJI were associated with impaired wound healing and falls (AUD, heart failure, and anemia) .…”

Section: Discussionmentioning

confidence: 99%

Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty

Weinstein,

Stephens-Shields,

Newcomb

et al. 2023

JAMA Netw Open

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ImportanceDespite the frequency of total knee arthroplasty (TKA) and clinical implications of prosthetic joint infections (PJIs), knowledge gaps remain concerning the incidence, microbiological study results, and factors associated with these infections.ObjectivesTo identify the incidence rates, organisms isolated from microbiological studies, and patient and surgical factors of PJI occurring early, delayed, and late after primary TKA.Design, Setting, and ParticipantsThis cohort study obtained data from the US Department of Veterans Affairs (VA) Corporate Data Warehouse on patients who underwent elective primary TKA in the VA system between October 1, 1999, and September 30, 2019, and had at least 1 year of care in the VA prior to TKA. Patients who met these criteria were included in the overall cohort, and patients with linked Veterans Affairs Surgical Quality Improvement Program (VASQIP) data composed the VASQIP cohort. Data were analyzed between December 9, 2021, and September 18, 2023.ExposuresPrimary TKA as well as demographic, clinical, and perioperative factors.Main Outcomes and MeasuresIncident hospitalization with early, delayed, or late PJI. Incidence rate (events per 10 000 person-months) was measured in 3 postoperative periods: early (≤3 months), delayed (between &gt;3 and ≤12 months), and late (&gt;12 months). Unadjusted Poisson regression was used to estimate incidence rate ratios (IRRs) with 95% CIs of early and delayed PJI compared with late PJI. The frequency of organisms isolated from synovial or operative tissue culture results of PJIs during each postoperative period was identified. A piecewise exponential parametric survival model was used to estimate IRRs with 95% CIs associated with demographic and clinical factors in each postoperative period.ResultsThe 79 367 patients (median (IQR) age of 65 (60-71) years) in the overall cohort who underwent primary TKA included 75 274 males (94.8%). A total of 1599 PJIs (2.0%) were identified. The incidence rate of PJI was higher in the early (26.8 [95% CI, 24.8-29.0] events per 10 000 person-months; IRR, 20.7 [95% CI, 18.5-23.1]) and delayed periods (5.4 [95% CI, 4.9-6.0] events per 10 000 person-months; IRR, 4.2 [95% CI, 3.7-4.8]) vs the late postoperative period (1.3 events per 10 000 person-months). Staphylococcus aureus was the most common organism isolated overall (489 [33.2%]); however, gram-negative infections were isolated in 15.4% (86) of early PJIs. In multivariable analyses, hepatitis C virus infection, peripheral artery disease, and autoimmune inflammatory arthritis were associated with PJI across all postoperative periods. Diabetes, chronic kidney disease, and obesity (body mass index of ≥30) were not associated factors. Other period-specific factors were identified.Conclusions and RelevanceThis cohort study found that incidence rates of PJIs were higher in the early and delayed vs late post-TKA period; there were differences in microbiological cultures and factors associated with each postoperative period. These findings have implications for postoperative antibiotic use, stratification of PJI risk according to postoperative time, and PJI risk factor modification.

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“…On the one hand, anemic patients should supplement blood volume and they need an allogeneic blood transfusion after operation, which will cause a variety of adverse reactions, affect the patient’s immune system and blood coagulation system, and increase the incidence of complications [ 28 ]. On the other hand, as the postoperative anemia in patients with hip fracture is relatively severe, the transport of nutrients in the fracture site will be affected, which weakens the body’s defense barrier and hinders the ability of self-repair, thus resulting in the invasion of pathogenic microorganisms, with the final manifestation being a rise in the incidence of complications [ 29 ]. Uncorrected anemia after hip fracture may hinder the functional recovery of patients with hip fracture and have effect on medical complications and LOS [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Construction and validation of a risk prediction model for delayed discharge in elderly patients with hip fracture

Cao

Chang

et al. 2023

BMC Musculoskelet Disord

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Background Because of their poor physical state, elderly hip fracture patients commonly require prolonged hospitalization, resulting in a drop in bed circulation rate and an increased financial burden. There are currently few predictive models for delayed hospital discharge for hip fractures. This research aimed to develop the optimal model for delayed hospital discharge for hip fractures in order to support clinical decision-making. Methods This case-control research consisted of 1259 patients who were continuously hospitalized in the orthopedic unit of an acute hospital in Tianjin due to a fragility hip fracture between January and December 2021. Delayed discharge was defined as a hospital stay of more than 11 days. The prediction model was constructed through the use of a Cox proportional hazards regression model. Furthermore, the constructed prediction model was transformed into a nomogram. The model’s performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA). the STROBE checklist was used as the reporting guideline. Results The risk prediction model developed contained the Charlson Comorbidity Index (CCI), preoperative waiting time, anemia, hypoalbuminemia, and lower limbs arteriosclerosis. The AUC for the risk of delayed discharge was in the training set was 0.820 (95% CI,0.79 ~ 0.85) and 0.817 in the testing sets. The calibration revealed that the forecasted cumulative risk and observed probability of delayed discharge were quite similar. Using the risk prediction model, a higher net benefit was observed than when considered all patients were at high risk, demonstrating good clinical usefulness. Conclusion Our prediction models could support policymakers in developing strategies for the optimal management of hip fracture patients, with a particular emphasis on individuals at high risk of prolonged LOS.

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Iron Deficiency Anemia is Associated with Increased Early Postoperative Surgical and Medical Complications Following Total Hip Arthroplasty

Cited by 22 publications

References 28 publications

Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty

Construction and validation of a risk prediction model for delayed discharge in elderly patients with hip fracture

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