Incidence and Risk Factors Associated with Human Albumin Administration Following Total Joint Arthroplasty.

Abstract

BackgroundHuman albumin (HA) administration is associated with an increased risk of acute renal failure and most other complications in patients undergoing total hip or knee arthroplasty (THA, TKA). Therefore, it is vital to reduce the use of HA and identify risk factors for its use. This study aims to determine the incidence and risk factors of HA administration in patients undergoing THA or TKA.MethodsWe identified patients undergoing THA or TKA in multiple institutions from 2014 to 2016 and collected patient demographics and perioperative variables. The criterion of HA administration was defined as a postoperative albumin level < 32 g/L or 32 to 35 g/L for at-risk patients. We compared 14 variables between patients who received HA administration and those who did not after stratification by the preoperative albumin (pre-ALB) level. Multivariate regressions identified the independent risk factors associated with HA administration.ResultsIn total, 958 (20.3 %) of 4713 patients undergoing THA and 410 (9.7 %) of 4248 patients undergoing TKA received HA administration. In addition to pre-ALB < 35 g/L, preoperative anemia (odds ratio [OR] 2.12, P = 0.001; OR 1.39, P < 0.001) and drain use (OR 3.33, P = 0.001; OR 4.25, P < 0.001) were also independent risk factors for HA administration after THA regardless pre-ALB < 35 g/L or not, and patients undergoing TKA diagnosed of rheumatoid arthritis or ankylosing spondylitis tended to receive HA administration regardless pre-ALB < 35 g/L or not (OR 3.67, P = 0.002; OR 2.06, P < 0.001).ConclusionThe incidence of HA administration was high in patients undergoing THA or TKA, and several variables were risk factors for HA administration. This finding may aid surgeons in preoperatively identifying patients requiring HA administration and optimizing perioperative managements.