Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty
Abstract
:1. Introduction
2. Methods
2.1. Data Collection
2.2. Outcome Measures
2.3. Statistical Analysis
3. Results
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Preoperative Characteristics | |
---|---|
Age, mean ± SD (years) | 66.5 ± 11.1 |
Sex, n (female/male) | 2109/1645 |
Body Mass Index, mean ± SD (kg/m2) | 29.5 ± 5.8 |
ASA score, median (IQR) | 2 (2–3) |
Medical history, n (%) | |
Cardiovascular disease | 834 (22.2) |
Pulmonary disease | 649 (17.3) |
Renal disease | 246 (6.6) |
Diabetes | 534 (14.2) |
High blood pressure | 2399 (63.9) |
Hypothyreosis | 660 (17.6) |
Smoker | 450 (12) |
Depression | 179 (4.8) |
Rheumatic disease | 70 (1.9) |
Thrombophilia | 235 (6.3) |
Haemophilia | 20 (0.5) |
Long-term aspirin | 672 (17.9) |
Long-term anticoagulation | 358 (9.5) |
Blood parameters | |
Haemoglobin, ±SD (g/dL) | 14.1 ± 1.4 |
Haematokrit, ±SD (%) | 42.4 ± 3.9 |
Thrombocytes, ±SD (103/µL) | 242.9 ± 61.8 |
Serum creatinine, ±SD (µmol/L) | 77.8 ± 27.7 |
eGFR, ±SD (mL/min) | 84.5 ± 21.2 |
C-reactive protein (mg/dL) | 0.6 ± 0.9 |
PTT (s) | 34.2 ± 4.6 |
Quick (%) | 100.4 ± 13.0 |
Intraoperative characteristics | |
Type of surgery, n (hip arthroplasty/knee arthroplasty) | 1948/1806 |
Use of i.v. tranexamic acid, n (%) | 1013 (27.0) |
Use of local tranexamic acid, n (%) | 461 (12.3) |
Type of anaesthesia (general/neuraxial) | 2247/1507 |
Duration of surgery, mean ± SD (min) | 86.6 ± 23.2 |
Autologous RBC transfusion, n (%) | 625 (16.6) |
Postoperative characteristics | |
Allogeneic RBC transfusion, n (%) | 179 (4.8) |
Perioperative complications, n (%) | 239 (6.4) |
Wound site complications (SSI/PJI) | 20 (0.5) |
Periprosthetic fracture | 6 (0.2) |
Prosthesis malposition/dislocation | 5 (0.1) |
Need for Intensive Care | 17 (0.5) |
Postoperative delirium | 30 (0.8) |
Decubitus | 20 (0.5) |
Cardiac complications | 52 (1.4) |
Pneumonia | 10 (0.3) |
Fall | 17 (0.5) |
Hepatic complication | 5 (0.1) |
Neurological complications | 22 (0.5) |
Renal complications | 55 (1.5) |
Gastrointestinal complications | 27 (0.7) |
DVT/LE | 3 (0.1) |
Preoperative Variables | B | S.E. | Exp (B) | p |
---|---|---|---|---|
(a) | ||||
Constant | 8.182 | 1.484 | 3576.322 | <0.001 |
Haemoglobin | −0.779 | 0.069 | 0.459 | <0.001 |
Cardiovascular disease | 0.897 | 0.192 | 2.453 | <0.001 |
Body Mass Index | −0.068 | 0.018 | 0.934 | <0.001 |
Diabetes | −0.941 | 0.282 | 0.390 | 0.001 |
ASA score | 0.581 | 0.181 | 1.788 | 0.001 |
Haemophilia | 2.088 | 0.690 | 8.067 | 0.002 |
Thrombocytes | −0.004 | 0.001 | 0.996 | 0.003 |
eGFR | −0.012 | 0.004 | 0.988 | 0.004 |
Age | 0.021 | 0.009 | 1.021 | 0.027 |
Nagelkerke R Square | 0.320 | |||
(b) | ||||
Constant | −4.652 | 0.949 | 0.010 | <0.001 |
ASA score | 0.545 | 0.131 | 1.724 | <0.001 |
Age | 0.044 | 0.008 | 1.045 | <0.001 |
eGFR | −0.012 | 0.003 | 0.988 | 0.001 |
Quick | −0.015 | 0.005 | 0.985 | 0.002 |
Nagelkerke R Square | 0.096 |
Preop. eGFR < 60 mL/min n = 416 (11.1%) | OR (95%CI) | Preop. Hb < 13 g/dl n = 666 (17.7%) | OR (95% CI) | Preop. BMI < 22 kg/m2 n = 198 (5.3%) | OR (95% CI) | |
---|---|---|---|---|---|---|
Outcome Measures | ||||||
RBC transfusion, n (%) | 62 (14.9) | 4.82 (3.48–6.68) | 197 (16.1) | 8.02 (5.87–10.96) | 19 (9.6) | 2.51 (1.39–4.56) |
Complications, n (%) | 57 (13.7) | 2.75 (2.00–3.78) | ||||
Wound site complications | 2 (0.5) | 0.89 (0.21–3.85) | ||||
Periprosthetic fracture | 2 (0.5) | 4.02 (0.74–22.04) | ||||
Prosthesis malposition/migration | 1 (0.2) | 2.01 (0.22–18.0) | ||||
Need for Intensive Care | 4 (1.0) | 2.48 (0.81–7.65) | ||||
Postoperative delirium | 4 (1.0) | 1.24 (0.43–3.56) | ||||
Decubitus | 1 (0.2) | 0.42 (0.06–3.15) | ||||
Cardiac complications | 12 (2.9) | 2.45 (1.27–4.7) | ||||
Pneumonia | 1 (0.2) | 0.89 (0.11–7.05) | ||||
Fall | 5 (1.2) | 3.37 (1.18–9.61) | ||||
Hepatic complication | 1 (0.2) | 2.0 (0.22–18.0) | ||||
Neurological complications | 3 (0.7) | 1.27 (0.37–4.3) | ||||
Renal complications | 28 (6.7) | 8.84 (5.16–15.16) | ||||
Gastrointestinal complications | 6 (1.4) | 2.31 (0.93–5.76) | ||||
DVT/LE | 1 (0.2) | 4.02 (0.36–44.4) |
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Jakuscheit, A.; Schaefer, N.; Roedig, J.; Luedemann, M.; von Hertzberg-Boelch, S.P.; Weissenberger, M.; Schmidt, K.; Holzapfel, B.M.; Rudert, M. Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty. J. Pers. Med. 2021, 11, 1223. https://doi.org/10.3390/jpm11111223
Jakuscheit A, Schaefer N, Roedig J, Luedemann M, von Hertzberg-Boelch SP, Weissenberger M, Schmidt K, Holzapfel BM, Rudert M. Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty. Journal of Personalized Medicine. 2021; 11(11):1223. https://doi.org/10.3390/jpm11111223
Chicago/Turabian StyleJakuscheit, Axel, Nina Schaefer, Johannes Roedig, Martin Luedemann, Sebastian Philipp von Hertzberg-Boelch, Manuel Weissenberger, Karsten Schmidt, Boris Michael Holzapfel, and Maximilian Rudert. 2021. "Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty" Journal of Personalized Medicine 11, no. 11: 1223. https://doi.org/10.3390/jpm11111223