Preoperative hematocrit on early prosthetic joint infection and deep venous thrombosis rates in primary total hip arthroplasty: A database study

Abstract

Background: Total hip arthroplasty (THA) is a very successful surgery in restoring a patient's quality of life. Infection is a devastating complication of THA. Many risks factors for infection in THA have been identified but little is known of the effect by preoperative hematocrit. Purpose: We aimed to evaluate the effect of preoperative hematocrit on early superficial site infections, deep infections, and deep organ space infections. Methods: Our study cohort included patients undergoing a THA in the ACS National Surgical Quality Improvement Program database from 2006 to 2015. We conducted a multivariate logistic regression analysis to evaluate an association between preoperative hematocrit and infection controlling for patients demographics and known risk factors. Results: A total of 98,869 patients were identified in this study. Of these, 702 (0.71%) developed a superficial site infection, 314 (0.32%) a deep infection, and 226 (0.23%) an organ space infection. Our results suggested a significant increased risk of deep infection (OR = 2.38, p = 0.0120) and organ space infection (OR = 3.05, p = 0.0234) in patients with lower preoperative hematocrit (<41). In addition, patients with lower preoperative hematocrit had higher chance to receive postoperative transfusion (OR = 2.93, p < 0.0001). However, no significant associations between preoperative hematocrit and superficial site infections (p = 0.8554), wound dehiscence (p = 0.0660) and DVT (p = 0.9236) were detected. Conclusion: Low preoperative hematocrit is associated with increased risk of deep, organ space infections, and postoperative transfusion in THA, but not with superficial site infections, wound dehiscence and DVT.

Risk factors for deep surgical site infection following surgically treated peri-ankle fractures: a case–control study based on propensity score matching

“…The lower hematocrit was also found to be associated with increased risk of DSSI in this study, in line with the previous reports. Willis et al [ 28 ] found the increased 2.38-fold risk of DSSI and 3.05-fold risk of organ space infection associated with preoperative lower hematocrit, but not for superficial infection, following 98,869 cases of total hip arthroplasty. Keswani et al [ 29 ] demonstrated that lower preoperative hematocrit was not only an independent risk for 30-day complications including deep wound infection, but also increased the 30-day unplanned readmission or severe adverse event by 5.24 times following revision shoulder arthroplasty.…”

“…Specific at trauma, lower hematocrit may represent an acute blood loss status after fracture, also may reflect the concurrent medical condition or nutritional status. Anyhow, it is prudent to appropriately delay surgery, or consider addition of an iron supplement or erythropoietin to restore blood stores prior to surgery [ 28 , 30 ].…”

The Impact of Preoperative Anemia on Complications After Total Shoulder Arthroplasty

“…Previous investigations have identified that preoperative anemia is associated with an increased rate of complications after total joint arthroplasty. 24 25 26 27 28 29 Viola et al 28 identified an association between preoperative anemia, defined by hemoglobin <12 g/dL for women and <13 g/dL for men, and increased rates of postoperative complications and mortality after total knee arthroplasty and total hip arthroplasty. Similarly, Grosso et al 25 identified preoperative anemia, defined by hematocrit <36%, as a notable risk factor for mortality, renal complications, respiratory complications, sepsis, wound infection, and UTI after THA.…”