Preoperative Anemia Increases Postoperative Complications and Mortality Following Total Joint Arthroplasty

Viola, Jessica; Gómez, Miguel M.; Restrepo, Camilo; Maltenfort, Mitchell; Parvızı, Javad

doi:10.1016/j.arth.2014.12.026

Cited by 118 publications

(68 citation statements)

References 17 publications

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“…According to our results, the most important modifiable risk factor associated with major perioperative complications and prolonged hospital stay was preoperative anemia. This finding is in agreement with prior studies that found anemia to be associated with cardiovascular complications and to be also a predisposing factor for periprosthetic joint infections [13,[17][18][19]. Blood transfusion-related immunomodulation (TRIM) may be one of the main reasons for the association between preoperative anemia and surgical site infection [20].…”

Section: Discussionsupporting

confidence: 91%

Perioperative Complications and Length of Stay After Revision Total Hip and Knee Arthroplasties: An Analysis of the NSQIP Database

Liodakis

Bergeron

Zukor

et al. 2015

The Journal of Arthroplasty

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Section: Discussionsupporting

confidence: 91%

Perioperative Complications and Length of Stay After Revision Total Hip and Knee Arthroplasties: An Analysis of the NSQIP Database

Liodakis

Bergeron

Zukor

et al. 2015

The Journal of Arthroplasty

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“…Preoperative anemia in patients undergoing major elective orthopedic surgery is associated with increased postoperative complications . Over the years efforts have been made to combine blood management modalities to improve patient outcomes and reduce blood transfusion and its associated risks .…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative anemia in patients undergoing elective total hip and knee replacement has been associated with increased transfusion, length of stay (LOS), and postoperative complications . Over the years different methods have been applied in an attempt to reduce blood loss and improve outcomes such as the use of tranexamic acid and the implementation of enhanced recovery programs .…”

Section: Algorithm Developmentmentioning

confidence: 99%

Preoperative screening and intervention for mild anemia with low iron stores in elective hip and knee arthroplasty

et al. 2017

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BACKGROUND Preoperative anemia in patients undergoing elective hip and knee arthroplasty is associated with increased postoperative morbidity and mortality, red blood cell (RBC) transfusion, and length of stay (LOS). The aim of this study was to assess the effect of optimizing hemoglobin (Hb) levels before elective primary hip and knee arthroplasty. STUDY DESIGN AND METHODS This is a prospective comparative cohort study of patients who underwent elective hip and knee arthroplasty before (control) and after (intervention) the launch of a Hb optimization program. Patients with anemia followed an agreed upon algorithm dependent on their medical history and blood variables taken on listing for surgery. The primary outcome for this study was the requirement for allogenic RBC transfusion. Secondary outcomes included hospital LOS, admission to critical care, readmission, medical complications, incidence of thromboembolic events, mortality, and costs. RESULTS A total of 1814 control patients operated between February 2012 and February 2013 were compared to 1622 intervention patients operated between February 2013 and May 2014. In the intervention group transfusion was significantly reduced (108 [6%] vs. 63 [4.1%], p = 0.005) as well as readmission (81 [4.5%] vs. 48 [2.3%], p= 0.020) and critical care admission (23 [1.3%] vs. 9 [0.5%], p = 0.030). LOS was significantly reduced from 3.9 days to 3.6 days (p = 0.017). The saving for the cohort was £263,000 ($342,000). CONCLUSIONS Algorithm‐led preoperative anemia screening and management in elective arthroplasty was associated with reduced RBC transfusion, readmission, critical care admission, LOS, and costs.

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“…Anaemia is more prevalent in patients undergoing revision surgery in association with increasing age and comorbidities. Adopting the WHO thresholds for anaemia, the prevalence of anaemia has been reported as 13%14 and 19%15 for primary TKA compared with 42%4 for revision TKA.…”

Section: Preoperativementioning

confidence: 99%

Blood management in total knee arthroplasty: state-of-the-art review

et al. 2018

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Total blood loss from primary total knee arthroplasty may exceed 2 L with greater blood loss during revision procedures. Blood loss and allogeneic transfusion are strongly associated with adverse outcomes from surgery including postoperative mortality, thromboembolic events and infection. Strategies to reduce blood loss and transfusion rates improve patient outcomes and reduce healthcare costs. Interventions are employed preoperatively, intraoperatively and postoperatively. The strongest predictor for allogeneic blood transfusion is preoperative anaemia. Over 35% of patients are anaemic when scheduled for primary and revision knee arthroplasty, defined as haemoglobin <130 g/L for men and women, and the majority of cases are secondary to iron deficiency. Early identification and treatment of anaemia can reduce postoperative transfusions and complications. Anticoagulation must be carefully managed perioperatively to balance the risk of thromboembolic event versus the risk of haemorrhage. Intraoperatively, tranexamic acid reduces blood loss and is recommended for all knee arthroplasty surgery; however, the optimal route, dose or timing of administration remains uncertain. Cell salvage is a valuable adjunct to surgery with significant expected blood loss, such as revision knee arthroplasty. Autologous blood donation is not recommended in routine care, sealants may be beneficial in select cases but further evidence of benefit is required, and the use of a tourniquet remains at the discretion of the surgeon. Postoperatively, restrictive transfusion protocols should be followed with a transfusion threshold haemoglobin of 70 g/L, except in the presence of acute coronary syndrome. Recent studies report no allogeneic transfusions after primary knee arthroplasty surgery after employing blood conservation strategies. The current challenge is to select and integrate different blood conserving interventions to deliver an optimal patient pathway with a multidisciplinary approach.

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Preoperative Anemia Increases Postoperative Complications and Mortality Following Total Joint Arthroplasty

Cited by 118 publications

References 17 publications

Perioperative Complications and Length of Stay After Revision Total Hip and Knee Arthroplasties: An Analysis of the NSQIP Database

Perioperative Complications and Length of Stay After Revision Total Hip and Knee Arthroplasties: An Analysis of the NSQIP Database

Preoperative screening and intervention for mild anemia with low iron stores in elective hip and knee arthroplasty

Blood management in total knee arthroplasty: state-of-the-art review

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