Increasing severity of anemia is associated with poorer 30-day outcomes for total shoulder arthroplasty

Abstract

Background Total shoulder arthroplasty (TSA) has increased in utilization over the past several decades. Anemia is a common preoperative condition among patients undergoing TSA and has been associated with poorer outcomes in other surgical procedures. To the best of our knowledge, no study has analyzed the association between anemia severity and TSA outcomes. Therefore, the purpose of this study is to determine the effects that increasing severity of anemia may have on the postoperative outcomes in patients receiving primary TSA. Methods A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from the years 2015 to 2018. Current Procedure Terminology code 23472 was used to identify all primary TSA procedures recorded during this time frame. Patients with greater than 38% preoperative hematocrit (HCT) were classified as having normal HCT levels. Patients with HCT values between 33% and 38% were classified as having mild anemia. All patients with less than 33% HCT were classified as having moderate/severe anemia. Patient demographic information, preoperative risk factors, and postoperative outcomes were compared among the 3 cohorts. A multivariate logistic regression including demographic factors and comorbidities was performed to determine whether increasing severity of anemia is independently associated with poorer postoperative outcomes. Results Of the 15,185 patients included in this study, 11,404 had normal HCT levels, 2962 patients were mildly anemic, and 819 patients had moderate to severe anemia. With increasing severity of anemia, there was an increased average hospital length of stay (1.6 vs. 2.1 vs. 3.0 days, P < .001), rate of readmissions (2.3% vs. 4.8% vs. 7.0%, P < .001), and rate of all reoperations (1.1% vs. 1.8% vs. 3.1%, P < .001). There was a statistically significant increase in both minor (1.9% vs. 2.7% vs. 4.4%, P < .001) and major (1.2% vs. 2.4% vs. 4.3%, P < .001) postoperative complication rates as well. Multivariate analysis identified anemia as an independent predictor of readmissions, reoperations, minor complications, and major complications. Conclusion We found increasing severity of anemia to be associated with progressively worse 30-day postoperative outcomes. This is consistent with the outcomes found for increasing severity of anemia in patients receiving other total joint procedures. Using preoperative HCT levels may be a useful tool for predicting the risk of postoperative complications in patients undergoing TSA. This information could be used to further optimize patient selection for primary TSA.

Preoperative anemia and its severity are associated with postoperative deep vein thrombosis in lower limb trauma patients: a cohort study

“…Our study revealed a signi cant association between preoperative anemia (HCT < 39% in males and < 36% in females) and postoperative DVT in patients with lower limb bone trauma, which aligns with the results of previous studies [7], to avoid the interference of blood transfusion on the research results, we performed separate analyses for patients with and without blood transfusion respectively. Our results showed that in patients without perioperative blood transfusion, mild anemia only slightly increased the incidence of postoperative DVT (OR:1.369, 95%CI [0.839-2.236], p = 0.209), which was consistent with previous ndings [5,8]. However, the postoperative DVT risk in patients with moderate to severe anemia in the three groups was 1.742, 2.056, and 3.373 times higher than that in patients without anemia, respectively.…”

“…Preoperative anemia is highly prevalent in patients with bone trauma, which the rate could be raised to 24-47.9% [4][5][6], and there are limited number of studies have found that anemia is a possible risk factor for perioperative DVT in patients with bone trauma currently [4,7,8]. Preoperative anemia associated with increased worse postoperative outcomes and length of stay, moreover, a decrease in the mass of red blood cells during anemia may leads to tissue hypoxia and iron de ciency associated with an increased concentration of factor VIII, all are risk factors for thrombosis [5,9]. Red blood cells play an essential role in formation of thrombosis, and the mechanism by which high hematocrit (HCT) levels promote venous thrombosis through increased blood viscosity has been recognized.…”

Anemia Severity and the Risks of Postoperative Complications and Extended Length of Stay Following Primary Total Elbow Arthroplasty

“…9 We found that increased severity of anemia resulted in greater length of hospital stay from 2.3 days in nonanemic patients to 4.9 days in severely anemic patients. Doan and colleagues 11 demonstrated similar stepwise increased LOSs following total shoulder arthroplasty from 1.6 days to 3.0 days as severity of anemia worsened. As orthopedic surgery transitions into value-based care through bundled payment models, cost-controlling measures such as limiting short-term complications, readmissions, and reoperations remain paramount.…”

“…9 In total joint arthroplasty of the shoulder, preoperative anemia severity has been demonstrated to influence perioperative complications including blood transfusions and other major complications. [10][11][12] Furthermore, intraoperative blood transfusion has been shown to be associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. 13,14 No studies to date have evaluated the impact of anemia severity on outcomes after primary TEA.…”

Relationship between the severity of preoperative anemia and postoperative deep vein thrombosis in patients with bone trauma: a cohort study

“…However, increasing evidence has shown that red blood cells play an active role in blood coagulation [7][8][9], beyond changes in blood ow mechanics. The preoperative anemia rate in patients with bone trauma range from 24-47.9% [5,10,11],…”