Predictors of Perioperative Blood Loss in Total Joint Arthroplasty

Park, Jai Hyung; Rasouli, Mohammad R.; Mortazavi, Seyed Mohammad Javad; Tokarski, Anthony T.; Maltenfort, Mitchell; Parvızı, Javad

doi:10.2106/jbjs.l.01335

Cited by 177 publications

(139 citation statements)

References 29 publications

(33 reference statements)

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“…The hypothesis that cigarette smoke may lead to vastly different outcomes in circulation responses depending on anatomic location may be important. Although in recent years there has been more of an effort to further understand the perioperative bleeding and transfusion risk factors for patients undergoing elective surgery [18,19,23,36,37,41], the role that smoking may play was not examined in these studies. There is even less research on these issues in spinal surgery [27]; Zheng et al [53] were among the first to look at predictors of blood loss and transfusion use in patients undergoing spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The most-definitive available research in the area of orthopaedics has been performed in the setting of total joint arthroplasty [18]. However, subsequent studies in that subspecialty failed to incorporate smoking status in their variable analyses [23,36,37,39,41]. Zheng et al [53] incorporated smoking in their analysis of factors affecting blood loss and transfusions in patients undergoing revision lumbar decompression, fusion, and instrumentation.…”

Section: Introductionmentioning

confidence: 99%

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Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about the association between smoking and intraoperative blood loss and perioperative transfusion use in patients undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical patients had been well documented, the aspect of blood loss seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection. Questions/Purposes We asked: (1) Is smoking associated with increased estimated blood loss during surgery in patients undergoing lumbar spine surgery? (2) Is smoking associated with increased perioperative transfusion usage?Methods Between 2005 and 2009, 581 lumbar decompression procedures (with or without fusion) were performed at one academic spine center. Of those, 559 (96%) had sufficient chart documentation to categorize patients by smoking status, necessary intra-and postoperative data to allow analysis with respect to bleeding and transfusion-related endpoints, and who did not meet exclusion criteria. Exclusion criteria included: patients whose smoking status did not fit in our two categories, patients with underlying coagulopathy, patients receiving anticoagulants (including aspirin and platelet inhibitors), history of hepatic disease, history of platelet disorder or other blood dyscrasias, and patient or family history of any other known bleeding disorder. Smoking history in packs per day was obtained for all subjects. We defined someone as a smoker if the patient reported smoking up until the day of their surgical procedure; nonsmokers were patients who quit smoking at least 6 weeks before surgery or had no history of smoking. We used a binomial grouping for whether patients did or did not receive a transfusion perioperatively. Age, sex, number of levels of discectomies, number of levels decompressed, number of levels fused, and use of instrumentation were recorded. The same approaches were used for transfusions in all patients regardless of smoking history; decisions were made in consultation between the surgeon and the anesthesia team. Absolute indications for transfusion postoperatively were: a hemoglobin less than 7 g/dL, continued symptoms of dizziness, tachycardia, decreased exertional tolerance, or hypotension that failed to respond to fluid resuscitation. Multiple linear regression analyses correcting for the above variables were performed to determine associations with intraoperative blood loss, while logistic regression was used to analyze perioperative transfusion use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…allogeneic or autologous blood transfusions [2,7,32,45,46]. Although infrequent, allogeneic transfusions carry important medical risks, including bloodborne infections, allergic and hemolytic reactions, and transfusion-associated sepsis [2,15,16,18,36,37,41].…”

Section: Introductionmentioning

confidence: 99%

“…Although infrequent, allogeneic transfusions carry important medical risks, including bloodborne infections, allergic and hemolytic reactions, and transfusion-associated sepsis [2,15,16,18,36,37,41]. Transfusion of preoperatively donated autologous blood is a theoretically safer, yet more costly and logistically difficult alternative [2,18,32].…”

Section: Introductionmentioning

confidence: 99%

Minorities Are Less Likely to Receive Autologous Blood Transfusion for Major Elective Orthopaedic Surgery

Menendez

Ring

2014

Clinical Orthopaedics &Amp; Related Research

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Background Surgeons commonly arrange for patients to perform autologous blood donation before elective orthopaedic surgery. Understanding sociodemographic patterns of use of autologous blood transfusion can help improve quality of care and cost containment. Questions/purposes We sought to determine whether there were (1) racial disparities, (2) insurance-based disparities, or (3) income-based disparities in autologous blood use. Additionally, we evaluated the combined effect of (4) race and insurance and (5) race and income on autologous blood use, and we compared ratios of autologous with allogeneic blood use.

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“…Some studies have not shown benefits 9,10 , while others have demonstrated decreased blood loss, fewer respiratory complications, and a lower risk of thromboembolism with regional anesthesia 11,35,36 . In a recent retrospective analysis from the National Joint Registry for England and Wales of ninety-day mortality after total hip replacement, spinal anesthesia, but not epidural anesthesia, was associated with a lower mortality rate 5 .…”

mentioning

confidence: 99%

Effects of Regional Versus General Anesthesia on Outcomes After Total Hip Arthroplasty

Helwani

Avidan

Abdallah

et al. 2015

The Journal of Bone and Joint Surgery-American Volume

148

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Predictors of Perioperative Blood Loss in Total Joint Arthroplasty

Cited by 177 publications

References 29 publications

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

Minorities Are Less Likely to Receive Autologous Blood Transfusion for Major Elective Orthopaedic Surgery

Effects of Regional Versus General Anesthesia on Outcomes After Total Hip Arthroplasty

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