Surgical site infection and transfusion rates are higher in underweight total knee arthroplasty patients

Abstract

BackgroundUnderweight (UW) patients undergoing total hip arthroplasty have exhibited higher complication rates, including infection and transfusion. No study to our knowledge has evaluated UW total knee arthroplasty (TKA) patients. We, therefore, conducted a study to investigate if these patients are at increased risk for complications, including infection and transfusion.MethodsA case-control study was conducted using a prospectively collected institutional database. Twenty-seven TKA patients were identified as UW (body mass index [BMI] < 18.5 kg/m2) from 2000-2012 and were matched for age, gender, date of surgery, age-adjusted Charlson comorbidity index, rheumatoid arthritis, and diabetes. These patients were compared to 81 normal weight patients (BMI 18.5-24 kg/m2). Demographic variables were compared, along with wound complications, surgical site infection (SSI), blistering, deep vein thrombosis, pulmonary embolism, transfusion, revision, flexion contracture, hematoma formation, and patellar clunk.ResultsThe average BMI was 17.1 kg/m2 (range 12.8-18.4) for UW and 23.0 kg/m2 (range 19.0-25.0) for normal weight patients (P < .001). UW TKA patients were more likely to develop SSIs (3/27, 11.1% vs 0/81, 0.0%, P = .01) and were more likely to require transfusions (odds ratio = 3.4, confidence interval 1.3-9.1; P = .02).ConclusionsOur study demonstrates that UW TKA patients have a higher likelihood of developing SSI and requiring blood transfusions. The specific reasons are unclear, but we conjecture that it may be related to decreased wound healing capabilities and low preoperative hemoglobin. Investigation of local tissue coverage and hematologic status may be beneficial in this patient population to prevent SSI. Based on the results of this study, a prospective evaluation of these factors should be undertaken.

Transfusion trends in hip arthroplasty in Korea: a nationwide study by the Korean National Health Insurance Service

“…Although allogeneic blood transfusions are restricted to reduce the adverse effects of blood transfusion in most cases, the risks include perioperative joint infection, systemic infection, internal organ damage, prolonged hospital stay, venous thromboembolic events, and mortality . Immunologically, allogeneic blood transfusions generally cause up regulation of humoral immunity and down regulation of macrophage and T‐cell immunity.…”

“…In this nationally representative study of patterns of transfusion use in hip arthroplasty, we observed significantly high rates of blood transfusion among patients undergoing hip arthroplasties regardless of risk factors including patient, hospitals, and other characteristics, compared with studies in other countries . Furthermore, this study is the first of its kind to estimate the economic burden of transfusion associated with hip arthroplasty in Korea.…”

Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin

“…The issue of underdosing becomes even more important when one considers the fact that the majority of patients not receiving an adequate dose of vancomycin were obese and those overdosed were likely to be underweight patients. Obese patients are at higher risk of PJI in the first instance [15,25] and depriving them of adequate perioperative antibiotic prophylaxis may have an additional adverse effect on the rate of PJI. It is also possible that the signal of increased PJI observed in obese patients may in part be a result of inadequate perioperative antibiotics.…”

The Effectiveness and Safety of General and Spinal Anesthesia on Systemic Inflammatory Response in Patients with Tumor-Type Total Knee Arthroplasty

“…When soft tissue repair was performed during surgery, the soft tissue area of the transplant was not sufficient to completely repair the defective tissue, resulting in a large range of artificial tibial prostheses directly under the skin. Artificial prostheses that lost soft tissue cushioning might cause late-onset infection during later rehabilitation training and exercise [22,23].…”