Chronic Thrombocytopenia and In-Hospital Outcomes After Primary Total Hip and Knee Arthroplasty

Wang, Yan; Zhang, Yu; Wang, Yicun; Han, Hedong; Zhao, Jianning; Wang, Jun

doi:10.1016/j.arth.2021.08.032

Cited by 4 publications

(8 citation statements)

References 24 publications

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“…These were stepwise increases in comparison to patients with platelet counts ≥100,000 to 150,000/mL, suggesting platelet counts <100,000/mL as an important marker for postoperative complications after orthopaedic operations. 14 Recently, a National Inpatient Sample database study by Wang et al 15 found that chronic thrombocytopenia was associated with higher costs and longer lengths of hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, recent national database studies with larger cohorts by Malpani et al and Wang et al found that platelet counts less than 116,000/mL and 150,000/mL, respectively, correlated with longer length of stay. 13,15…”

Section: Discussionmentioning

confidence: 99%

“…However, larger database studies by Malpani et al and Wang et al show significantly higher rates of readmission and both medical and surgical complications after THA and TKA in patients with abnormally low platelet levels. 13,15…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Total Knee and Hip Arthroplasty in Patients With Perioperative Thrombocytopenia

Bujnowski

Scheidt

Diaz

et al. 2023

J Am Acad Orthop Surg

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Background: Thrombocytopenia is an abnormally low level of blood platelets (less than 150,000/mL) resulting in an increased risk for bleeding. Typically, patients with platelet levels below 50,000/mL should delay arthroplasty or be transfused with platelets before surgery. However, existing studies are mixed regarding the effects of more moderate thrombocytopenia in terms of total knee and hip arthroplasty outcomes. Methods: This level III retrospective chart review examined the effects of different severities of preoperative thrombocytopenia on length of hospitalization, readmission, and transfusion rates in 5,617 primary total knee and hip arthroplasties at one tertiary academic medical center. Preoperative platelet levels were sectioned into clinically relevant groups and compared with clinical outcomes using univariable and multivariable models. Results: On univariate analysis, having platelet levels of ,100,000/mL and 100 to 149,000/mL was associated with a longer length of stay. However, after controlling individual demographics, there was no association between platelet levels and length of stay, nor with 30-day readmission. Finally, on univariate analysis, patients with platelet levels of ,100,000/mL and 100 to 149,000/mL were more likely to have a blood transfusion, which remained true for those with ,100,000/mL after controlling for individual demographics. Conclusions: Total hip and total knee arthroplasty are safe in patients with varying platelet levels and not associated with increased length of stay or 30-day readmission. However, patients with more severe thrombocytopenia are more likely to receive red blood cell transfusions than patients with milder thrombocytopenia. Thrombocytopenia is an abnormally low level of blood platelets (less than 150,000/mL) resulting in an increased risk for excessive bleeding. 1 It can be relatively mild (100,000 to 149,000/mL) and asymptomatic, moderate (50,000 to 99,000/mL), or severe (,50,000/mL). 2,3

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of Total Knee and Hip Arthroplasty in Patients With Perioperative Thrombocytopenia

Bujnowski

Scheidt

Diaz

et al. 2023

J Am Acad Orthop Surg

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“…Для выявления статических разли- обСуждение В настоящее время в отечественной и зарубежной литературе уделяется недостаточно внимания проблемам хирургического лечения пациентов с идиопатической тромбоцитопенией. По данным Y. Wang с соавторами, частота выявления тромбоцитопении среди пациентов, которым выполняется эндопротезирование ТБС, составляет 1,43% и ежегодно увеличивается [10]. Ряд авторов сообщают об увеличении числа осложнений и послеоперационной летальности среди пациентов, которым эндопротезирование ТБС выполняется на фоне тромбоцитопении.…”

Section: статистический анализunclassified

“…В нашем исследовании преобладали женщины среднего возраста (Me -47,24; min -19, max -84 года), что косвенно свидетельствует о разных эпидемиологических показателях распространения ИПТ в популяции. Средние сроки госпитализации пациентов с ИТП при эндопротезировании ТБС увеличиваются на 26% [10]. В нашем исследовании средний сроки госпитализации пациентов группы I был больше на 14,5% по сравнению с группой II, но существенно ниже по сравнению с данными, представленными в литературе.…”

Section: таблица 3 интраоперационные показатели у пациентов групп исс...unclassified

Total Hip Arthroplasty in Patients with Idiopathic Thrombocytopenic Purpura

Цед

Муштин

Dulaev³

2022

Traumatology and Orthopedics of Russia

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Background There are no national clinical guidelines for the perioperative management of patients with idiopathic thrombocytopenia in hip arthroplasty. Most of the publications are presented in the context of general surgery, the distinguishing feature of which is the good achievement of hemostasis. However, it is impossible to achieve such a level of hemostasis with hip arthroplasty. The aim of the study was to evaluate the mid-term results of total hip arthroplasty in patients with primary idiopathic thrombocytopenia. Material and methods. Randomized monocenter clinical trial of 38 patients with idiopathic thrombocytopenia hip arthroplasty was performed. These patients constituted the main study group. As a comparison group, the outcomes of surgical treatment of 40 patients over the same observation period were analyzed. The mean follow-up period was 4.3 years. Exclusion criteria for the study were heparin-induced thrombocytopenia, a severe form of idiopathic thrombocytopenia in the acute stage with platelet counts less than 25*109/L. Results. The average length of hospitalization is longer among patients with idiopathic thrombocytopenia (11.1), it was possible to identify statistical significance of differences in the preoperative period. The results indicate a longer preoperative preparation, including the transfusion of hemocomponents with repeated monitoring of the parameters of the clinical blood test and coagulogram. There was no significant difference in the duration of the surgical intervention, but there were differences in the amount of intraoperative blood loss and the volume of blood transfusion. Among the patients of the control group (without idiopathic thrombocytopenia), only three patients required intraoperative transfusion of 1 dose of erythrocyte suspension, patients of the main group (thrombocytopenia) more often underwent blood transfusion. In the structure of complications in the first group, complications were noted in 5 patients, in the second group in one patient, which is not statistically significant (p=0.067), but the relative risk of complications was 5.2. Functional results 12 months after surgery do not differ. Conclusion. The mid-term results of hip arthroplasty are comparable to the results of arthroplasty in patients of the general population. A distinctive feature of surgical intervention is an increase in the average volume of intraoperative blood loss and the need for a significantly larger transfusion of hemocomponents not only during the operation, but also in the preoperative period, which increases the duration of hospitalization.

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