Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort Study

Wu, En-Bo; Hung, King-Chü; Juang, Sin-Ei; Chin, Jo-Chi; Lu, Hsin-Chun; Ko, Jih‐Yang

doi:10.3390/jpm12030434

Cited by 7 publications

(6 citation statements)

References 76 publications

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“…Total knee arthroplasty (TKA) and total hip arthroplasty (THA) can result in substantial perioperative blood loss, which has been associated with postoperative morbidity and mortality 1-3 . Tranexamic acid (TXA) has been increasingly utilized because of its efficacy in the reduction of blood loss following total joint arthroplasty (TJA) 4,5 .…”

mentioning

confidence: 99%

Tranexamic Acid Is Safe in Patients with a History of Venous Thromboembolism Undergoing Total Joint Arthroplasty

Richardson,

Liu,

Mayfield

et al. 2023

Journal of Bone and Joint Surgery

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Background: Tranexamic acid (TXA) is increasingly utilized during total knee arthroplasty (TKA) and total hip arthroplasty (THA) to decrease blood loss; however, there are concerns with regard to potential thromboembolic complications, particularly in high-risk patients. This study sought to define a subset of patients at elevated risk for thromboembolic complications following total joint arthroplasty (TJA) and to compare postoperative outcomes between patients who received TXA and those who did not. Methods: Patients who underwent primary, elective TJA from 2015 to 2021 were identified in the Premier Healthcare Database. Patients with a history of venous thromboembolism, defined as a history of pulmonary embolism or deep vein thrombosis, were identified and formed the high-risk cohort. Patient demographic characteristics, hospital factors, patient comorbidities, antithrombotic medication use, perioperative blood transfusion, and 90-day complications were assessed and compared between patients who received TXA and those who did not. Univariate regression and multivariable regression were performed to account for potential confounders. Results: The high-risk cohort comprised 70,759 patients who underwent TJA, of whom 46,074 (65.1%) received TXA and 24,685 (34.9%) did not. After controlling for confounding factors, patients in the TXA cohort had similar risks of pulmonary embolism (adjusted odds ratio [OR], 0.90 [95% confidence interval (CI), 0.79 to 1.02]; p = 0.097), stroke (adjusted OR, 0.97 [95% CI, 0.69 to 1.37]; p = 0.867), and myocardial infarction (adjusted OR, 0.93 [95% CI, 0.69 to 1.24]; p = 0.614) compared with patients who did not receive TXA. Patients who received TXA demonstrated decreased risks of transfusion (adjusted OR, 0.42 [95% CI, 0.38 to 0.46]; p < 0.001) and 90-day readmission (adjusted OR, 0.87 [95% CI, 0.80 to 0.94]; p < 0.001). Conclusions: TXA utilization was not associated with an increased risk of postoperative pulmonary embolism, stroke, or myocardial infarction in patients with a history of venous thromboembolism. Furthermore, patients who received TXA had a decreased risk of transfusion and readmission. This evidence suggests that TXA may be safely utilized among select high-risk patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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mentioning

confidence: 99%

Tranexamic Acid Is Safe in Patients with a History of Venous Thromboembolism Undergoing Total Joint Arthroplasty

Richardson,

Liu,

Mayfield

et al. 2023

Journal of Bone and Joint Surgery

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“…THR surgeries are associated with a higher Hb drop due to several factors, most notably osteotomy and excision of a highly vascularized part of bone. Total knee replacement also showed an increase in a study done among knee arthroplasty patients in Taiwan [17], with 3.34 g/dL compared to 2.8 g/dL postoperatively. As reported above, replacement surgeries are expected to have a higher Hb drop as they deal with highly vascularized bone structure and are associated with osteotomies and excisions.…”

Section: Discussionmentioning

confidence: 95%

“…Tere was no signifcant diference (p � 0.08) in mean Hb drop between regional anesthesia and GA even though the mean showed GA having a lower mean compared to regional anesthesia. Tis difered from a study done in Taiwan [17] in a retrospective study that showed patients who underwent spinal anesthesia were less likely to lose blood than patients undergoing GA. Regional anesthesia is more often associated with less blood loss, with the sympathetic nerve blockage causing less blood oozing.…”

Section: Advances In Orthopedicsmentioning

confidence: 99%

Postoperative Hemoglobin Drop and the Associated Factors among Elective Orthopedic Surgeries in Northern Tanzania

Ashir,

Maya,

Saiyed

et al. 2024

Advances in Orthopedics

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Background. Having an estimated level of Hb drop in different orthopedic surgeries would help plan for surgery from pre- to postoperative periods. The aim of this study was to assess the Hb drop and the associated factors during the intraoperative period among elective orthopedic surgeries. Methods. This was an analytic cross-sectional study conducted between October 2022 and March 2023, which included all patients admitted for elective orthopedic surgery who met the inclusion criteria. Data were collected before and after the patient was operated on. Information was analyzed using t-tests and ANOVA to establish the statistical significance of the Hb drop. Results. A total of 195 participants were enrolled. The majority of the participants were male (62.1%), with the main etiology of symptoms being motor traffic accidents (31.8%). The most affected site was the femur (36.4%), followed by the spine (23.6%). The highest mean Hb drop was in total hip replacement surgeries (4.19 g/dL), with the overall mean Hb drop being 2.75 g/dL. A statistically significant difference was identified in diathermy use, duration of surgery, and patients with chronic illnesses. Conclusion. With a mean Hb drop of 2.75 g/dL, the application of diathermy and surgeries with shorter durations resulted in a reduced Hb drop. These factors should be incorporated to minimize the drop in Hb in orthopedic surgeries. Accounting for differences in surgeries, there should not be delays in patients who have a preoperative Hb level that can sustain the mean Hb drop recorded in the study.

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“…Additionally, Hart et al showed that simultaneous bilateral TKA had significantly higher rates of transfusion within 72 hours after the surgical procedure at 37.7% compared with unilateral TKA at 10.9% (p < 0.0001) 12 . Furthermore, acute blood loss is a known risk factor for ischemic sequelae such as stroke and myocardial infarction and may be a risk factor for symptomatic pulmonary embolism and venous thromboembolism [30][31][32][33] .…”

Section: Discussionmentioning

confidence: 99%

Complications and Safety of Simultaneous Bilateral Total Knee Arthroplasty

Richardson

Liu

Mayfield

et al. 2023

Journal of Bone and Joint Surgery

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Background: Total knee arthroplasty (TKA) is a highly successful surgical procedure that decreases pain and improves function. Many patients who undergo TKA may require surgical intervention on both extremities because of bilateral osteoarthritis. The purpose of this study was to evaluate the safety of simultaneous bilateral TKA compared with that of unilateral TKA. Methods: Patients who underwent unilateral or simultaneous bilateral primary, elective TKA from 2015 to 2020 were identified using the Premier Healthcare Database. Subsequently, the simultaneous bilateral TKA cohort was matched to the unilateral TKA cohort in a 1:6 ratio by age, sex, race, and presence of pertinent comorbidities. Patient characteristics, hospital factors, and comorbidities were compared between the cohorts. The 90-day risks of postoperative complications, readmission, and in-hospital death were assessed. Differences were assessed using univariable regression, and multivariable regression analyses were performed to account for potential confounders. Results: Overall, 21,044 patients who underwent simultaneous bilateral TKA and 126,264 matched patients who underwent unilateral TKA were included. After accounting for confounding factors, patients who underwent simultaneous bilateral TKA demonstrated a significantly increased risk of postoperative complications, including pulmonary embolism (adjusted odds ratio [OR], 2.13 [95% confidence interval (CI), 1.57 to 2.89]; p < 0.001), stroke (adjusted OR, 2.21 [95% CI, 1.42 to 3.42]; p < 0.001), acute blood loss anemia (adjusted OR, 2.06 [95% CI, 1.99 to 2.13]; p < 0.001), and transfusion (adjusted OR, 7.84 [95% CI, 7.16 to 8.59]; p < 0.001). Patients who underwent simultaneous bilateral TKA were at increased risk of 90-day readmission (adjusted OR, 1.35 [95% CI, 1.24 to 1.48]; p < 0.001). Conclusions: Simultaneous bilateral TKA was associated with increased rates of complications including pulmonary embolism, stroke, and transfusion. Orthopaedic surgeons and patients should consider these potential complications when contemplating simultaneous bilateral TKA. When simultaneous bilateral TKA is pursued, patient counseling and thorough medical optimization should be performed. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort Study

Cited by 7 publications

References 76 publications

Tranexamic Acid Is Safe in Patients with a History of Venous Thromboembolism Undergoing Total Joint Arthroplasty

Tranexamic Acid Is Safe in Patients with a History of Venous Thromboembolism Undergoing Total Joint Arthroplasty

Postoperative Hemoglobin Drop and the Associated Factors among Elective Orthopedic Surgeries in Northern Tanzania

Complications and Safety of Simultaneous Bilateral Total Knee Arthroplasty

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