Total knee Arthroplasty: risk factors for allogeneic blood transfusions in the South Asian population

Abstract

BackgroundTotal knee arthroplasty (TKA) is the recommended treatment for end-stage knee osteoarthritis. Considering the various risks associated with intra and postoperative blood transfusions, better understanding is required with respect to the risk factors contributing to a greater possibility of blood transfusion during or after surgery. Although literature highlights several such factors, our study is among the first to identify these risk factors in the South Asian population which differs from other populations in several ways.MethodsThe study consists of a review of 658 patients undergoing TKA from 2005 to 2015. Data was obtained from patient medical records and was analysed using logistic regression analysis. The relationship between each predictor and the outcome variable was calculated as an Odds ratio (OR), the threshold of significance for which was p = 0.25 and p = 0.05 for univariate and multivariable analysis respectively.ResultsThe mean age of the patient population was 63 years (78% female), 25% of whom received one or more blood transfusions. Multivariable analysis revealed 5 significant independent predictors for increased risk of blood transfusions including bilateral knee surgery (OR:5.51), preoperative anemia (OR:4.15), higher ASA (American Society of Anaesthesiologists) status (3–4) (OR:1.92), female sex (OR:3.44) and BMI (Body mass index) ≤30 (OR:1.79) while increasing co-morbidities and age (>60) were found to be insignificant.ConclusionsThe factors identified for the South Asian population are largely similar to those for other populations. Identification of high risk patients will permit the application of an international multipronged approach which not only targets the modifiable risk factors but also the decision making process and blood management protocols in order to minimize the transfusion associated risks for a patient undergoing a TKA.

Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty

“…Compared with those undergoing unilateral TKA, patients undergoing simultaneous bilateral TKA have a higher risk of transfusion. Similar results have been described in previous studies, and longer operation times and more perioperative blood loss may be the reason behind this result [18][19][20]. Our study suggested that patients with lower BMIs had a higher risk of transfusion.…”

Association between Type of Anesthesia and Risk of Blood Transfusion Events in Primary Unilateral Total Knee Arthroplasty: A Secondary Analysis Based on a Cohort Study in Singapore

“…In our study, low preoperative Hb, CCF, ASA-PS (3), and GA were significantly independent risks for blood transfusion in TKA, which is consistent with the results of recently published studies. [20][21][22][23] However, none of them discussed the association between choice of anesthesia and the risk of blood transfusion events.…”

Efficacy and Safety of Intravenous Ferric Carboxymaltose in Patients with Postoperative Anemia Following Same-Day Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial

“…The Hb level criterion used for transfusion is decreasing. In our study, the criterion for blood transfusion was strictly limited to cases with a Hb level <7 g/dL [ 15 , 16 , 17 ]. However, a Hb threshold of 8 g/dL was applied to patients with cardiovascular disease [ 18 ].…”