Does Polycythemia Vera Increase Risk of Postoperative Complications Following Primary Total Joint Arthroplasty? A Retrospective Matched Control Cohort Study of 6932 Polycythemia Vera Patients

Labaran, Lawal; Amin, Raj M.; Sequeira, Sean B.; Puvanesarajah, Varun; Haug, Emanuel; Rao, Sandesh S.; Browne, James A.; Werner, Brian C.

doi:10.1016/j.arth.2019.10.050

Cited by 7 publications

(10 citation statements)

References 33 publications

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“…Moreover, this practice may be informed by reports of perioperative thrombo‐hemorrhagic complications often occurring in spite of optimally controlled cell counts, 4 consistent with many respondents' experience, perhaps leading some to believe that strict control may be futile. Also of note was the finding that approximately 25% of those surveyed reported holding ongoing cytoreductive therapy perioperatively, translating expressed concerns for wound healing and perioperative cytopenias, though these are not rigorously founded in our literature review 4,7–12 ; moreover, this practice contradicts our polled experts, who generally continue these agents perioperatively. Finally, we observed marked heterogeneity in terms of perioperative blood count targets and management of therapeutic agents, particularly low‐dose aspirin, which was held, in most instances, only for surgeries deemed at high risk by survey participants versus unanimously stopped (for variable durations) preoperatively by both global experts consulted.…”

Section: Figurementioning

confidence: 79%

Perioperative management of myeloproliferative neoplasms: A pan‐Canadian physician survey and international expert opinion

et al. 2022

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Myeloproliferative neoplasms (MPN), including polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF), are stem cell-derived hematologic malignancies characterized by variable rates of fibrotic and leukemic transformation with concurrent risk of both thrombotic and hemorrhagic complications. While surgery is recognized as a significant situational risk factor for thrombosis in the general population, 1 this risk has been predicated to be further increased in patients with MPN. In the surgical setting, the prothrombotic effect of elevated hematocrit (Hct), hyperviscosity, increased cell turnover,

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Section: Figurementioning

confidence: 79%

Perioperative management of myeloproliferative neoplasms: A pan‐Canadian physician survey and international expert opinion

et al. 2022

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“…Investigators associated these effects to Centers for Medicare & Medicaid Services initiating public reporting of hospital complication and readmission rates, thereby incentivizing hospitals and surgeons to provide high value care. Other instances suggestive of recent medical advancements include the following: improvements in neuraxial anesthetic techniques 28 ; development of enhanced recovery programs following TKA that reduce the incidence of severe complications and mortality 29,30 ; improvements in thromboembolic prophylaxis protocols 31,32 ; and increased push for optimization of modifiable comorbidities such as smoking and diabetes. 33,34 Considering the number of patients undergoing TKA who are morbidly obese (BMI !…”

Section: Discussionmentioning

confidence: 99%

30-Days to 10-Years Mortality Rates following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of the Last Decade (2011–2021)

et al. 2022

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Background Mortality data following primary total knee arthroplasty (TKA) beyond the 1-year postoperative time period is sparse. This systematic review and meta-analysis aimed to: 1) estimate contemporary mortality rates at 30-days, 90-days, 1-year, 5-years, and 10-years following primary TKA; and 2) identify risk factors and causes of mortality following TKA. Methods PubMed, MEDLINE, Cochrane, EBSCO host, and Google Scholar databases were queried from January 1, 2011 to October 30, 2021 for all studies reporting mortality rates following primary TKA. A meta-analysis of proportions was conducted using a random-effects model to ascertain pooled mortality rates (95% confidence interval [CI]). Meta-regression was utilized to account for confounding effects on mortality rates due to the study’s country of origin, median date of study data, average patient age, and patient gender ratios, with a level of significance maintained at P-value <0.05. Results A total of 44 articles were included in quantitative synthesis. The pooled 30-day mortality rate was 0.14%(95% CI:0.05%-0.22%; n=1,817,647). The pooled 90-day mortality rate was 0.35%(95% CI:0.0.28%-0.43%; n=1,641,974). The pooled 1-year mortality was 1.1%(95% CI:0.71%-1.49%; n=1,178,698). The pooled 5-year mortality rate was 5.38%(95% CI:4.35%-6.42%; n=597,041). The pooled 10-year mortality rate was 10.18%(95% CI:7.78 %-12.64 %; n=815,901). Our 30-day mortality rate was lower than previously reported. The most common causes of death at all time points were due to cardiac disease, cerebrovascular disease, and malignancy. Obesity demonstrated mixed effects on long term mortality rates. Conclusion Overall mortality rates of TKA remain low worldwide at all time points and immediate postoperative mortality rates continue to fall. Compared to symptomatic knee osteoarthritic patients reported in the literature, TKA patients qualitatively exhibited lower mortality rates, which may support the value of TKA in improving quality of life without associated excess mortality. Future long-term mortality studies should be conducted to account for geographical variability in mortality rates and further elucidate modifiable risk factors associated with mortality among TKA patients.

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“…The patients who underwent elective TJA under general anesthesia between 2018 and 2021 were deemed eligible for inclusion. The inclusion criteria 1 : age between 65 and 85 years, 2 underwent elective total hip arthroplasty or total knee arthroplasty under general anesthesia, 3 with a follow‐up over 30 days after the surgery. The exclusion criteria 1 : pre‐existing psychiatric (e.g., depression), neurological (e.g., Parkinson's disease) diseases, or other neurodegenerative conditions, 2 with visual, communication, or listening disorders, 3 with the conditions (e.g., hepatic dysfunction, hemopathy) affecting Alb and Fib levels 4 ; preoperative cognitive impairment 5 ; and incomplete data or loss to follow‐up.…”

Section: Methodsmentioning

confidence: 99%

“…1 Although TJA significantly improves the joint function and quality of life economically, the high prevalence of postoperative complications is a major clinical problem for patients after TJA, particularly for the elderly. 2 The incidence of postoperative complications among patients who underwent orthopedic surgery is reported as high as 16.5% by the International Surgical Outcomes Study. 3 Postoperative delirium (POD) is a very common and serious complication after the surgery, which is closely associated with many adverse consequences and a poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…Total joint arthroplasty (TJA) is widely performed for the treatment of severe trauma and arthritic joint diseases (including osteoporotic fracture, osteoarthritis, rheumatoid arthritis) 1 . Although TJA significantly improves the joint function and quality of life economically, the high prevalence of postoperative complications is a major clinical problem for patients after TJA, particularly for the elderly 2 . The incidence of postoperative complications among patients who underwent orthopedic surgery is reported as high as 16.5% by the International Surgical Outcomes Study 3 .…”

Section: Introductionmentioning

confidence: 99%

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Albumin/fibrinogen ratio, an independent risk factor for postoperative delirium after total joint arthroplasty

Jiang

Lei

2022

Geriatrics Gerontology Int

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Aim Postoperative delirium (POD) is a very common and serious complication after total joint arthroplasty (TJA), which is closely associated with many adverse consequences and a poor prognosis. This study aimed to establish the potential risk factors for POD. Methods In total, 336 patients who underwent elective TJA under general anesthesia between 2018 and 2021 were included and deemed eligible for inclusion. POD was diagnosed based on the criteria by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM V). The receiver operating characteristic curve was drawn to evaluate the predictive and cut‐off values of continuous variables for POD. Potential risk factors for POD were evaluated by binary univariate and multivariate analysis with the “Enter” method. Results According to the criteria by DSM V, 43 patients were categorized into the POD group, with an incidence of 12.8% (43 of 336). The receiver operating characteristic curve showed that albumin/fibrinogen ratio (AFR) was a good predictor for POD with an area under the curve of 0.754, cut‐off value of 9.65, sensitivity of 57.00% and specificity of 83.72% (P <0.001). A low preoperative AFR level (<9.65) was determined as the only independent risk factor for POD by the univariate and multivariate logistic regression analyses (OR: 2.45, 95% CI: 2.01–2.94, P = 0.008). Conclusions Our results indicate that a low AFR is an independent risk factor for POD in elderly subjects after TJA. Geriatr Gerontol Int 2022; 22: 412–417.

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Does Polycythemia Vera Increase Risk of Postoperative Complications Following Primary Total Joint Arthroplasty? A Retrospective Matched Control Cohort Study of 6932 Polycythemia Vera Patients

Cited by 7 publications

References 33 publications

Perioperative management of myeloproliferative neoplasms: A pan‐Canadian physician survey and international expert opinion

Perioperative management of myeloproliferative neoplasms: A pan‐Canadian physician survey and international expert opinion

30-Days to 10-Years Mortality Rates following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of the Last Decade (2011–2021)

Albumin/fibrinogen ratio, an independent risk factor for postoperative delirium after total joint arthroplasty

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