Medical comorbidities and perioperative allogeneic red blood cell transfusion are risk factors for surgical site infection after shoulder arthroplasty

Everhart, Joshua S.; Bishop, Julie Y.; Barlow, Jonathan D.

doi:10.1016/j.jse.2017.04.006

Cited by 42 publications

(43 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The transfusion rate after shoulder arthroplasty (2.3%) was lower in this cohort than rates reported in the literature, which can vary from 4.5% to 43%,1, 2, 3, 4, 5, 6, 7, 8 despite a diverse patient population and a similar rate of complex cases 2 . We found that 3 known perioperative risk factors in combination were predictive of transfusion: estimated blood loss, history of anemia, and preoperative hemoglobin.…”

Section: Discussioncontrasting

confidence: 46%

“…Patients undergoing shoulder arthroplasty are at risk for transfusion. Reported rates of transfusion after shoulder arthroplasty are variable and high, and range from 4.5% to 43% 1, 2, 3, 4, 5, 6, 7, 8. As the demand for shoulder arthroplasty continues to rise, 5 understanding risk factors predictive of transfusion has become more important.…”

mentioning

confidence: 99%

“…Transfusion of blood or blood components is a common medical procedure that carries inherent risks, including disease transmission, hemodynamic overload, and allergic reactions including anaphylaxis. Medical comorbidities and perioperative allogeneic red blood cell transfusion are risk factors for surgical site infection after shoulder arthroplasty 1 . Some patients may elect to decline blood transfusion for religious or moral reasons.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Estimated blood loss and anemia predict transfusion after total shoulder arthroplasty: a retrospective cohort study

et al. 2019

View full text Add to dashboard Cite

BackgroundReported blood transfusion rates after total shoulder arthroplasty (TSA) range from 4.5% to 43%, and reported risk factors include race, female sex, prosthesis type (reverse), revision, age, anemia, low preoperative hemoglobin, and number of comorbidities. The purpose of this study was to develop a predictive model for transfusion in anatomic/hemi and reverse shoulder arthroplasty patients and to estimate the transfusion rate in a community hospital setting.MethodsA retrospective cohort of 265 shoulder arthroplasties (79 anatomic, 182 reverse, and 4 hemiarthroplasties) performed consecutively by 1 surgeon at 1 institution from May 2013 to May 2016 was assembled. Two patients were excluded for insufficient data, leaving 263 patients for analysis. Sensitivity, specificity, area under the curve, and cut points using estimated blood loss (EBL), history of anemia, and preoperative hemoglobin level were calculated, based on a logistic regression model.ResultsThe overall transfusion rate was 2.3% (6/265). Higher EBL (P = .003), lower preoperative hemoglobin level (P = .030), and history of anemia (P = .088) were predictive of transfusion with a sensitivity of 80.0% and a specificity of 99.6%. In this cohort, patients with a history of anemia had transfusion risk when an EBL of ≥300 mL was combined with a preoperative hemoglobin level <10.9, resulting in a sensitivity of 1.0 and a specificity of 0.96. Factors associated with transfusion in univariate models included arthroplasty for fracture (P < .001), cemented stem (P < .001), length of stay (P < .001), EBL (P < .001), operative time (P < .001), and preoperative hemoglobin (P = .004) and hematocrit levels (P = .004).ConclusionPatients with a history of anemia, a preoperative hemoglobin level <10.9, and an intraoperative EBL ≥300 mL are at high risk for transfusion after TSA.

show abstract

Section: Discussioncontrasting

confidence: 46%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Estimated blood loss and anemia predict transfusion after total shoulder arthroplasty: a retrospective cohort study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Some of these variables include increased body mass index, comorbid cardiac disease, vascular disease, tobacco use, perioperative blood transfusion, and insurance status. 121314151617181920 With increased emphasis by the Centers for Medicare and Medicaid Services on value-based reimbursement programs and an overall surgeon concern for improving patient outcomes, it is essential to appropriately risk stratify patients and medically optimize patients before shoulder arthroplasty. This step is especially important in the elderly patient population because of an increased number and severity of medical comorbidities.…”

mentioning

confidence: 99%

Thirty-day Complications and Readmission Rates in Elderly Patients After Shoulder Arthroplasty

et al. 2018

View full text Add to dashboard Cite

Introduction:Shoulder arthroplasty procedures are increasingly being performed in older patients despite an increased perioperative risk. The purpose of this study is to determine the complications and 30-day readmission rates in the elderly population after shoulder arthroplasty and hemiarthroplasty.Methods:Total shoulder arthroplasty, reverse total shoulder arthroplasty, and hemiarthroplasty cases were collected from the National Surgical Quality Improvement Program database from 2006 to 2015. The 30-day complication and readmission rates, surgical time, discharge destination, and total hospital length of stay were calculated, comparing patients by age (elderly: ≥80 years; older: 65 to 79 years; younger: <65 years). Multivariable logistic regression analysis was performed to identify variables associated with any complication within 30 days of surgery.Results:Of 11,450 patients, 1,956 (17.1%) underwent shoulder hemiarthroplasty and 9,494 (82.9%) underwent total shoulder arthroplasty. By age group, 1,708 (14.9%) were ≥80, 6,073 (53.0%) were 65 to 79, and 3,669 (32.0%) were <65. The overall 30-day postoperative complication rate was significantly higher in elderly patients (15.3% versus 8.2% versus 6.8%; P < 0.001), length of stay (2.6 versus 2.1 versus 1.8 days; P < 0.001), and unplanned readmissions (5.5% versus 2.6% versus 2.3%; P < 0.001). The strongest independent variables significantly associated with any complication included revision arthroplasty indication (odds ratio [OR], 4.34; P < 0.001), fracture indication (OR, 4.14; P < 0.001), and history of cardiac disease (OR, 2.33; P < 0.001), followed by elderly age (OR, 2.01; P < 0.001).Conclusions:The 15.3% complication rate (major, 4.8%; minor, 10.7%), 2.6 days of average length of stay, and 5.5% unplanned readmission among elderly patients (>80) are significantly higher than younger patients. Although surgical indications and comorbidities are higher-quality predictors of complications, elderly patients should be appropriately counseled and medically optimized according to the perioperative risk profile before surgery.

show abstract

“…Das perioperative OP-Risiko (Infektionen!) ist für Patienten mit rheumatischen Erkrankungen gegenüber der Allgemeinbevölkerung erhöht [21,22]. Ko-Morbididäten wie Diabetes mellitus, Nikotinabusus oder Zahninfektionen sowie Glukokortikoidtherapie, bestimmte DMARDs (Disease Modifying Anti-Rheumatic Drugs) und nicht zuletzt eine Biologikumtherapie erhöhen dieses noch.…”

Section: Besonderheiten Der Operativen Orthopädischen Rheumatologieunclassified

Medizinisches Vorgehen in der Orthopädischen Rheumatologie

Henniger

Rehart

2018

Akt Rheumatol

View full text Add to dashboard Cite

ZusammenfassungDie orthopädische Rheumatologie befasst sich mit der Diagnostik und der konservativen sowie der operativen Behandlung von rheumatischen Erkrankungen am muskulo-skelettalen System. Um eine dauerhafte Remission der entzündlichen Aktivität einer rheumatischen Erkrankung zu erreichen, ist ein multidisziplinäres Therapiekonzept notwendig. Begleitend zur medikamentösen Therapie und angepasst an die Schwere der Erkrankung, bzw. die entzündliche Aktivität und den Grad der Destruktion von Gelenken, umfasst dieses verschiedene konservative und operative Maßnahmen. Die enge interdisziplinäre Kooperation mit internistischen Rheumatologen, Radiologen, Nuklearmedizinern, Anästhesisten und nicht zuletzt Ergo- und Physiotherapeuten sowie Orthopädietechnikern ist dabei unabdingbar. In der Therapie von rheumatischen Erkrankungen erfolgt in der Regel neben einer medikamentösen Basistherapie eine konservative Therapie an den Strukturen des muskulo-skelettalen Systems. Je nach Gelenk und Zustand umfasst diese alle lokalen Maßnahmen der physikalischen Therapie, Physiotherapie, Ergotherapie, Schienenversorgung, Einlagen- und Schuhversorgung, bzw. zuletzt Gelenkinfiltrationen. Erst, wenn mit diesen konservativen Maßnahmen keine ausreichende Wirkung erzielt wird, kommen operative Maßnahmen zum Einsatz. Ausnahmen hiervon sind absolute oder dringliche OP-Indikationen wie Nervenausfälle, ausgeprägte Achsabweichungen von Gelenken, ein rasches Fortschreiten der Destruktionen oder Sehnenrupturen. Je nach Gelenk und radiologischem Destruktionsgrad werden bei der operativen Therapie präventive/gelenkerhaltende von rekonstruktiven/gelenkersetzenden Verfahren unterschieden. Aufgrund des multilokulären Befalls sowohl artikulärer als auch ligamentärer Strukturen, v. a. aber der besonderen Medikation und deren potentiellen Nebenwirkungen gilt es, im operativen Bereich die Besonderheiten dieser Patientengruppe zu berücksichtigen.

show abstract

Medical comorbidities and perioperative allogeneic red blood cell transfusion are risk factors for surgical site infection after shoulder arthroplasty

Cited by 42 publications

References 41 publications

Estimated blood loss and anemia predict transfusion after total shoulder arthroplasty: a retrospective cohort study

Estimated blood loss and anemia predict transfusion after total shoulder arthroplasty: a retrospective cohort study

Thirty-day Complications and Readmission Rates in Elderly Patients After Shoulder Arthroplasty

Medizinisches Vorgehen in der Orthopädischen Rheumatologie

Contact Info

Product

Resources

About