Preoperative Anaemia in Primary Hip and Knee Arthroplasty

Abstract

Introduction Approximately one in three patients has untreated preoperative anaemia, which in turn is associated with an increased need for transfusion of allogenic red blood cell concentrates (RBC) and complications in the context of a surgical intervention. Here, the prevalence of preoperative and postoperative anaemia as well as their effects on transfusion rate, hospital length of stay and hospital mortality in primary hip and knee arthroplasty has been analysed. Methods From January 2012 to September 2018, 378,069 adult inpatients from 13 German hospitals were analysed on the basis of an anonymized registry. Of these, n = 10,017 patients had a hip and knee joint primary arthroplasty. The primary endpoint was the incidence of preoperative anaemia, which was analysed by the first available preoperative haemoglobin value according to the WHO definition. Secondary endpoints included in-hospital length of stay, number of patients with red blood cell concentrate transfusion, incidence of hospital-acquired anaemia, number of deceased patients, and postoperative complications. Results The preoperative anaemia rate was 14.8% for elective knee joint arthroplasty, 22.9% for elective hip joint arthroplasty and 45.0% for duo-prosthesis implantation. Preoperative anaemia led to a significantly higher transfusion rate (knee: 8.3 vs. 1.8%; hip: 34.5 vs. 8.1%; duo-prosthesis: 42.3 vs. 17.4%), an increased red blood cell concentrate consumption (knee: 256 ± 107 vs. 29 ± 5 RBC/1000 patients; hip: 929 ± 60 vs. 190 ± 16 RBC/1000 patients; duo-prosthesis: 1411 ± 98 vs. 453 ± 42 RBC/1000 patients). Pre-operative anaemia was associated with prolonged hospital stay (12.0 [10.0; 17.0] d vs. 11.0 [9.0; 13.0] d; p < 0.001) and increased mortality (5.5% [4.6 – 6.5%] vs. 0.9% [0.7 – 1.2%]; Fisher p < 0.001) compared to non-anaemic patients. In patients aged 80 years and older, the incidence of preoperative anaemia and thus the transfusion rate was almost twice as high as in patients under 80 years of age. Summary Preoperative anaemia is common in knee and hip primary arthroplasty and was associated with a relevant increase in red blood cell concentrate consumption. In the context of patient blood management, a relevant potential arises, especially in elective orthopaedic surgery, to better prepare elective patients, to avoid unnecessary transfusions and thus to conserve the valuable resource blood.

Implementation of an anaemia walk‐in clinic: Feasibility and preliminary data from the Orthopedic University Hospital

“…27 Possible causes of ID in elderly patients may also include malnutrition, dysfunctional enteral iron absorption or chronic blood loss. 3 Of all investigated parameters, iron parameters like ferritin and TSAT showed no significant differences between the anaemia and non-anaemia groups. Ret-He was significantly lower in the anaemia group compared to the non-anaemia group.…”

“…Reasons for anaemia in elderly orthopaedic patients may be caused by changes in stem cell physiology associated with inflammation, renal diseases or the use of multiple drugs 27 . Possible causes of ID in elderly patients may also include malnutrition, dysfunctional enteral iron absorption or chronic blood loss 3 . RBC consumption and LOS were increased in anaemic patients compared to non‐anaemic patients.…”

“…1 Within orthopaedic surgery, preoperative anaemia prevalence ranges from 14% for hip or knee endoprosthesis to 45% for duoprosthesis implantation. 2,3 Anaemia is associated with increased morbidity and mortality, prolonged hospital length of stay (LOS), intensive care admissions and red blood cell (RBC) transfusions. 1,[4][5][6][7] Anaemia-related postoperative complications are associated with increased medical costs, thus putting enormous pressure on health-care facilities.…”

“…Preoperative anaemia is common in surgical patients scheduled for major surgery 1 . Within orthopaedic surgery, preoperative anaemia prevalence ranges from 14% for hip or knee endoprosthesis to 45% for duo‐prosthesis implantation 2,3 . Anaemia is associated with increased morbidity and mortality, prolonged hospital length of stay (LOS), intensive care admissions and red blood cell (RBC) transfusions 1,4‐7 .…”

Tranexamsäure zur Blutungsprophylaxe bei Trauma und orthopädischen Eingriffen – Standard oder individualisierte Anwendung?

“…Neben operationstechnischen Unterschieden sind weitere unabhängige Risikofaktoren für eine Fremdblutgabe gut beschrieben und umfassen beispielsweise (1) die unbehandelte, präoperative Anämie, welche mit einer Prävalenz von ca. 14–23 % beobachtet wird [ 29 , 34 ] sowie (2) verlängerte Operationszeiten [ 7 , 46 ]. Darüber hinaus nehmen auch unterschiedliche Transfusionstrigger sowie das Flüssigkeits- und Volumenmanagement einen Einfluss.…”