Primary Joint Arthroplasty Surgery: Is the Risk of Major Bleeding Higher in Elderly Patients? A Retrospective Cohort Study

Quintero, Jorge I.; Cárdenas, Laura; Navas, Mónica; Bautista, María; Bonilla, Guillermo; Llinás, Adolfo

doi:10.1016/j.arth.2016.03.025

Cited by 11 publications

(9 citation statements)

References 31 publications

(38 reference statements)

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“…The sample size of this study was small, and the amount of postoperative blood loss was studied, which was consistent with the surgical bleeding in our study. Another study [ 25 ] including 1048 patients found that in joint replacement, people older than 70 were more likely to bleed, which was an independent risk factor, although the authors did not study the relationship between bone density and surgical bleeding. Our study has some suggestive significance for future clinical decision making.…”

Section: Discussionmentioning

confidence: 99%

Bone Density May Be a Promising Predictor for Blood Loss during Total Hip Arthroplasty

Zhu

Wei

Zhou

et al. 2022

JCM

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Background: Total hip arthroplasty (THA), which is performed mostly in elderly individuals, can result in substantial blood loss and thereby imposes a significant physical burden and risk of blood transfusion. The femoral neck cut and reamed acetabulum are the main sites of intraoperative bleeding. Whether the bone density in that region can be used to predict the amount of blood loss in THA is unknown. Methods: We retrospectively analyzed adult patients undergoing primary THA in the Department of Orthopedics, Peking Union Medical College Hospital, from January 2018 to January 2020. All these patients underwent primary unilateral THA. Patients had their bone mineral density (BMD) recorded within the week before surgery and were stratified and analyzed for perioperative blood loss. Multivariable regressions were utilized to adjust for differences in demographics and comorbidities among groups. Results: A total of 176 patients were included in the study. Intraoperative blood loss was 280.1 ± 119.56 mL. Pearson correlation analysis showed a significant correlation between blood loss and preoperative bone density of both the femoral greater trochanter (R = 0.245, p = 0.001) and the Ward’s triangle (R = 0.181, p = 0.016). Stepwise multiple linear regression showed that preoperative bone density of the greater trochanter (p = 0.015, 95% CI: 0.004–0.049) and sex (p = 0.002) were independent risk factors for THA bleeding. The area under the receiver operating characteristic curve (AUROC) of the greater trochanter and Ward’s triangle was 0.593 (95% CI: 0.507–0.678, p = 0.035) and 0.603 (95% CI: 0.519–0.688, p = 0.018), respectively. The cutoff T value on the femoral greater trochanter for predicting higher bleeding was −1.75. Conclusions: In THA patients, preoperative bone density values of the femoral greater trochanter and sex could be promising independent predictors for bleeding during surgery. Osteoporosis and female patients might have lower blood loss in the THA operation.

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Section: Discussionmentioning

confidence: 99%

Bone Density May Be a Promising Predictor for Blood Loss during Total Hip Arthroplasty

Zhu

Wei

Zhou

et al. 2022

JCM

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“…Transfusion rate has been correlated to age [ 22 ]. In our study, two patients out of 36 (5.5%) needed postoperative blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Total Knee Arthroplasty in Octogenarians: Should We Still Be so Restrictive?

et al. 2021

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Demand for total knee arthroplasty (TKA) in octogenarians will increase in subsequent years as society ages. We conducted a retrospective observational study in octogenarians operated on with TKA between 2015 and 2019, comparing preoperative and postoperative Knee Society Score (KSS), Knee Society Function Score (KSFS), extension and flexion balance, and radiologic alignment using a paired Student t-test. A chi-squared test was used to correlate mortality with Charlson comorbidities index score and with ASA scale. Kaplan–Meier analysis was performed to calculate patient survival. In this period 36 patients ≥80 years underwent TKA, with a mean age of 81.6 years. Of these, 24 patients (66.7%) were classified as ASA II and 12 (33.3%) as ASA III. Sixteen patients (44.4%) were Charlson 0, 14 (38.9%) Charlson 1, two (5.6%) Charlson 2, and four (11.1%) Charlson 3. KSS, KSFS, flexion and extension range, and radiologic alignment were statistically significant (p < 0.001) when comparing preoperatory and post-operatory data. No correlation (p > 0.05) was found between mortality and ASA or Charlson score. Seven patients (19.4%) suffered a medical complication and two patients experienced surgical complications. Four patient died (11.1%) during follow-up. The mean patient survival was 67.4 months. Patients ≥80 years achieve clinical improvement after TKA. Comorbidities, not age, are the burden for surgery in older patients.

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“…Persistent wound drainage or hematoma formation may also increase the risk of surgical site infection [ 21 ]. Known patient risk factors for bleeding after a TJA include female sex, pre-operative anemia, BMI < 30, Medicaid insurance, older age, and a higher comorbidity index [ 22 , 23 , 24 ]. The rate of major bleeding after a TJA with perioperative antithrombic agent administration has been reported between 1.7% and 18%, with variation depending on the definition of bleeding and the potency of antithrombic agents used [ 20 , 23 , 25 , 26 ].…”

Section: Overview Of Thromboembolism and Bleeding Events After Tjamentioning

confidence: 99%

Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty

et al. 2021

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Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. In this review, we provide a concise overview of society guidelines regarding the perioperative management of chronic antithrombotic agents in the setting of elective TJAs and summarize the recent literature that may inform future guidelines. Ultimately, antithrombotic regimen management should be patient-specific, in consultation with cardiology, internal medicine, hematology, and other physicians who play an essential role in perioperative care.

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Primary Joint Arthroplasty Surgery: Is the Risk of Major Bleeding Higher in Elderly Patients? A Retrospective Cohort Study

Cited by 11 publications

References 31 publications

Bone Density May Be a Promising Predictor for Blood Loss during Total Hip Arthroplasty

Bone Density May Be a Promising Predictor for Blood Loss during Total Hip Arthroplasty

Total Knee Arthroplasty in Octogenarians: Should We Still Be so Restrictive?

Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty

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