Association between preoperative hemoglobin and postoperative moderate and severe anemia among patients undergoing primary total knee arthroplasty: a single-center retrospective study

Cao, Guorui; Yang, Xiaolin; Xu, Hong; Chen, Yue; Huang, Zeyu; Zhang, Shaoyun; Quan, Songtao; Yao, Juan; Yang, Minglu; Pei, Fuxing

doi:10.1186/s13018-021-02727-5

Cited by 11 publications

(9 citation statements)

References 30 publications

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“…Several factors were identified to be irrelevant for postoperative anemia, such as age, smoking, drinking, drug taking, high CRP levels, comorbidities, etc. In previous researches, predictors like age, comorbidities, etc showed significant results and were included in the predictive models in previous researches ( 10 , 11 , 32 ); unfortunately, such relevance was not identified in this study, along with other factors such as high CRP levels, smoking, drug taking. The varied results across studies could be explained by diverse composition of patients, different tyoes of surgeries as well as the varied design of the studies.…”

Section: Discussionmentioning

confidence: 70%

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

2022

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IntroductionThe loss of blood is a significant problem in Total Knee Arthroplasty (TKA). Anemia often occurs after such surgeries, leading to serious consequences, such as higher postoperative infection rates and longer hospital stays. Tools for predicting possible anemia can provide additional guidance in realizing better blood management of patients.Methods2,165 patients who underwent TKA from 2015 to 2019 in the same medical center were divided into training and validation cohorts. Both univariate and multivariate logistic regression analyses were performed to identify independent preoperative risk factors for anemia. Based on these predictors, a nomogram was established using the area under the curve (AUC), calibration curve (AUC), and the area under the curve (AUC). The model was then applied to the validation cohort, and decision curve analyses (DCA) were also plotted.ResultsThrough analysis of both univariate and multivariate logistic regression, five independent predictors were found in the training cohort: female, relatively low BMI, low levels of preoperative hemoglobin, abnormally high levels of ESR, and simultaneously two sides of TKA in the same surgery. The AUCs of the nomogram were 74.6% (95% CI, 71.35%–77.89%) and 68.8% (95% CI, 63.37%–74.14%) of training and the validation cohorts separately. Furthermore, the calibration curves of both cohorts illustrated the consistency of the nomogram with the actual condition of anemia of patients after TKA. The DCA curve was higher for both treat-none and treat-all, further indicating the relatively high practicality of the model.ConclusionFemale, lower BMI, lower levels of preoperative Hb, simultaneous bilateral TKA, and high levels of preoperative ESR were figured out as five independent risk factors for postoperative anemia (<9.0 g/dL) in patients undergoing TKA. Based on the findings, a practical nomogram was constructed to predict risk of postoperative anemia. The evidence level should be level 4 according to guideline.

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Section: Discussionmentioning

confidence: 70%

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

2022

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“…The prevalence of iron deficiency anemia in non-hospitalized older adults is 16.6–25%; therefore, many patients who are scheduled for TKA may have preoperative iron deficiency anemia [ 23 ]. Preoperative anemia is a major risk factor for 30-day complications, including infection, cardiac complications, and prolonged hospital stay [ 20 , 21 , 30 ]. A preoperative Hb level of < 12.5 g/dL was associated with postoperative transfusion after TKA [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative anemia is a known risk factor for delayed postoperative rehabilitation and increased complications [ 20 , 21 ]. A previous study reported that approximately 26% of patients who had undergone elective orthopedic surgery had preoperative anemia [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of immediate postoperative intravenous iron supplementation after staged bilateral total knee arthroplasty

Lee

Moon

2023

BMC Musculoskelet Disord

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Background Approximately 26% of patients undergoing major orthopedic elective procedures have preoperative anemia. This study aimed to investigate the effect of intravenous (IV) iron supplementation on the hemoglobin (Hb) level after staged bilateral total knee arthroplasty (TKA) in patients with or without preoperative anemia. Methods We retrospectively analyzed 418 patients who underwent staged bilateral TKA (1 week interval). The iron group (n = 220) received IV iron isomaltoside immediately after each TKA. The no-iron group (n = 198) was recommended to receive transfusion if postoperative anemia was diagnosed between the first and second TKA. Preoperative anemia was present in 42 (21.2%) and 50 (22.7%) patients in the no-iron and iron groups, respectively. Demographic data, preoperative and postoperative Hb levels, Hb level change (preoperative minus postoperative 6-week Hb level), and blood drainage amount were compared between groups. Results The transfusion rate was lower in the iron group than in the no-iron group (96.5% vs. 58.6%, P < 0.001). Overall, the demographic data, preoperative and postoperative 6-week Hb levels, Hb level change, and blood drainage amount were not significantly different between the two groups. Among patients with preoperative anemia, the iron group showed lower Hb level change (0.6 ± 0.9 vs. 0.1 ± 1.1, P = 0.016). Conclusion Patients with preoperative anemia treated with IV iron showed lower Hb level change than did those without IV iron treatment. Despite the lower transfusion rate, the iron group showed similar postoperative 6-week Hb level and Hb level change to the no-iron group.

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“…This finding was consistent with other previous comparative studies. Cao, et al found that lower pre-operative hemoglobin (12.1 g/dl) and more intra-operative blood loss (130.9 ml) were independent risk factors for post-operative anemia [ 16 ]. In a large retrospective study with 2284 patients undergoing TKR, the authors reported that pre-operative anemia increased the rate of transfusion by 6.38 and 6.27 times in males and females, respectively [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Comparative Study Between Midvastus and Standard Medial Parapatellar Approaches for Total Knee Replacement Regarding the Peri-Operative Factors

Vasiliadis¹,

Chatziravdeli²,

Metaxiotis³

et al. 2022

Cureus

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The aim of this study was to determine whether the midvastus (MV) approach in patients who underwent total knee replacement (TKR) results in differences regarding peri-operative parameters, such as surgical time, blood loss, transfusion need and complications, when compared with medial parapatellar approach (MP). MethodsThis was a prospective randomized comparative study of patients who received primary TKR. The first group consisted of patients where the MP approach was used and the second those where the MV approach was utilized. Patient's age, body mass index (BMI), stage of osteoarthritis (OA), prosthesis design, duration of surgery, blood loss in the drainage, hemoglobin (Hb), and intra-operative complications were recorded. ResultsFrom December 2019 to June 2020 a total of 107 (22 males, 85 females) and 38 (seven males, 31 females) patients were operated on with the MP and MV approaches, respectively. The two groups did not differ in terms of age, BMI, gender and stage of OA, however, pre-operative haemoglobin (Hb) was higher in the MP group [mean 13,5 (1.3) versus 13.1 (0.73)]. There was no significant difference in Hb decline pre-and postoperatively and in drain volume between groups. The mean Hb drop was similar for the MP [-2.2 (1.08)] and MV [-2.52 (1.06)] groups, and even though the transfusion rates were lower for the MP group, it did not reach significance. The duration of surgery was significantly longer in the MV group, with a mean time of 95.6 (12.94) minutes versus 89.4 (14.28) in the MP group. Overall complications did not differ significantly among the two surgical approaches. Multivariate logistic regression demonstrated that pre-operative Hb [OR 2.6 95% CI (1.43, 4.75)] and approach [OR 4.15 95% CI (1.15, 14.98)] were significantly correlated with the need for transfusion when gender, BMI, redon drainage, prosthesis size and duration of surgery were considered together. ConclusionIn our experience, total knee replacement performed with either the midvastus or medial parapatellar approach does not result in any advantage with regards to the intra-operative complications, drain blood volume or difference in Hb drop post-operative. However, the midvastus approach presents a longer operation time, with the risk of higher transfusion rates for the patients.

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Association between preoperative hemoglobin and postoperative moderate and severe anemia among patients undergoing primary total knee arthroplasty: a single-center retrospective study

Cited by 11 publications

References 30 publications

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

Efficacy of immediate postoperative intravenous iron supplementation after staged bilateral total knee arthroplasty

A Prospective Randomized Comparative Study Between Midvastus and Standard Medial Parapatellar Approaches for Total Knee Replacement Regarding the Peri-Operative Factors

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