Preoperative Anemia Independently Predicts Significantly Increased Odds of Short-Term Complications Following Aseptic Revision Hip and Knee Arthroplasty

Gu, Alex; Chen, Aaron Z.; Selemon, Nicolas A.; Tornberg, Haley; Wei, Chapman; Fassihi, Safa C.; Campbell, Joshua C.; Sculco, Peter K.

doi:10.1016/j.arth.2020.10.061

Cited by 16 publications

(13 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among the five, preoperative hemoglobin seems to be the most influential predictor; this has already been validated in multiple previous studies. Gu et.al revealed that preoperative mild anemia was significantly associated with a series of postoperative complications including anemia which required transfusion ( 27 ). Similar conclusions were also given by other group of researchers ( 13 , 28 ), and predictive models included the factor as key predictor ( 10 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

2022

View full text Add to dashboard Cite

show abstract

“…In our study, rather than eliminating only ICD-9 and ICD-10 codes related to periprosthetic joint infection, we individually evaluated each diagnosis and excluded any diagnosis related to infection that may have been coded incorrectly. Second, this study lacks external validation; however, we performed temporal validation and our model performance is comparable to those of previous studies that have performed external validation [6, 8]. Third, many of the comorbid conditions we studied were not stratified in terms of their severity, which may alter postoperative complication rates or the ability to determine their impact on perioperative risk.…”

Section: Discussionmentioning

confidence: 75%

“…It is imperative to risk-stratify patients preoperatively, and studies have demonstrated how derangements in preoperative hemoglobin and sodium levels increase postoperative morbidity and mortality in aseptic revision THA or TKA [6,7,13,14]. However, to the best of our knowledge, machine learning has not been used in the setting of aseptic revision THA or TKA to determine which preoperative laboratory values and patient medical comorbidities are associated with adverse outcomes postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Machine-learning Models Predict 30-Day Mortality, Cardiovascular Complications, and Respiratory Complications After Aseptic Revision Total Joint Arthroplasty

Abraham

Booth

Geiger

et al. 2022

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background Aseptic revision THA and TKA are associated with an increased risk of adverse outcomes compared with primary THA and TKA. Understanding the risk profiles for patients undergoing aseptic revision THA or TKA may provide an opportunity to decrease the risk of postsurgical complications. There are risk stratification tools for postoperative complications after aseptic revision TKA or THA; however, current tools only include nonmodifiable risk factors, such as medical comorbidities, and do not include modifiable risk factors. Questions/purposes (1) Can machine learning predict 30day mortality and complications for patients undergoing aseptic revision THA or TKA using a cohort from the American College of Surgeons National Surgical Quality Improvement Program database? (2) Which patient variables are the most relevant in predicting complications? Methods This was a temporally validated, retrospective study analyzing the 2014 to 2019 National Surgical Quality Improvement Program database, as this database captures a large cohort of aseptic revision THA and TKA patients across a broad range of clinical settings and includes preoperative laboratory values. The training data set was 2014 to 2018, and 2019 was the validation data set. Given that predictive models learn expected prevalence of outcomes, this split allows assessment of model performance in contemporary patients. Between 2014 and 2019, a total of 24,682 patients underwent aseptic revision TKA and 17,871 patients underwent aseptic revision THA. Of those, patients with CPT codes corresponding to aseptic revision TKA or THA were considered as potentially eligible. Based on excluding procedures involving unclean wounds, 78% (19,345 of 24,682) of aseptic revision TKA procedures and 82% (14,711 of 17,871) of aseptic revision THA procedures were eligible. Ten percent of patients in each of the training and validation cohorts had missing predictor variables. Most of these missing data were preoperative Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Ethical approval for this study was obtained from the institutional review board at the Naval Medical Center Portsmouth, VA, USA.

show abstract

“…Although detection of perioperative anemia is of primary importance, anesthesia may play a role in preventing or minimizing adverse outcomes in patients with severe anemia, which we define as a hematocrit level <30%, based on previous studies [ 10 ]. In particular, neuraxial anesthesia as an alternative to general anesthesia has been associated with decreased transfusion and postoperative complication risk following TJA [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

The Association of Primary Anesthesia Type With Postoperative Transfusion in Anemic Patients Undergoing Primary Total Joint Arthroplasty

Kim¹,

Curran²,

Du³

et al. 2022

Cureus

View full text Add to dashboard Cite

Background and objective A high rate of preoperative anemia has been observed in patients undergoing knee and hip arthroplasty. The type of anesthesia that patients receive may play a role in preventing or minimizing adverse outcomes in these patients. In this study, we aimed to examine the complication rates in patients with severe anemia undergoing this surgery. In addition, we explore whether neuraxial anesthesia is associated with better outcomes compared to general anesthesia. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) registry was used to extract data related to patients who underwent total hip or knee arthroplasty from 2014 to 2016. Only those patients with a hematocrit level <30% were included, and they were classified into two groups based on primary anesthesia type received: neuraxial versus general anesthesia. The primary outcome of interest was postoperative transfusion. Secondary outcomes included 30-day hospital readmission and postoperative complications. Multivariable logistic regression was used to model primary anesthesia type to outcomes while controlling for various confounders. The odds ratio (OR) and their 95% confidence intervals (CI) were reported. Results There were 1,723 patients with severe anemia included in our analysis, of which 41.2% received neuraxial anesthesia. Among patients that received neuraxial versus general anesthesia, 170 (31.08%) and 486 (41.33%), respectively, received a postoperative blood transfusion (p<0.001). On multivariable regression analysis, neuraxial anesthesia was associated with 40% decreased odds of postoperative transfusion (OR: 0.63, 95% CI: 0.51-0.79, p<0.0001), but it was not associated with any other outcomes. Conclusion Neuraxial anesthesia can reduce the risk of postoperative transfusion in severely anemic patients undergoing total joint arthroplasty (TJA), ultimately leading to reduced discomfort, hospital expenditure, and adverse outcomes.

show abstract

Preoperative Anemia Independently Predicts Significantly Increased Odds of Short-Term Complications Following Aseptic Revision Hip and Knee Arthroplasty

Cited by 16 publications

References 18 publications

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

Predict Postoperative Anemia of Patients: Nomogram Construction and Validation

Machine-learning Models Predict 30-Day Mortality, Cardiovascular Complications, and Respiratory Complications After Aseptic Revision Total Joint Arthroplasty

The Association of Primary Anesthesia Type With Postoperative Transfusion in Anemic Patients Undergoing Primary Total Joint Arthroplasty

Contact Info

Product

Resources

About