Real World Incidence and Prevalence of Low Back Pain: A Systematic Review

Abstract

Objectives: In the current era of bundled payments, greater focus has been placed on preoperative patient optimization. This study examined the prevalence of preoperative anemia from 2007-2017 among patients undergoing elective total joint arthroplasty (TJA) and its association with transfusion. MethOds: This retrospective analysis used healthcare claims data from the Optum ClinformaticsTM Data Mart database (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017). Patient selection criteria included: hospitalization for elective TJA, age ≥ 18, and no diagnosis of a hematologic disorder. Patients were required to have at least one (90 days prior to admission) laboratory value for hemoglobin (Hgb); the most recent Hgb value was used to define anemia using the World Health Organization criteria. Logistic regression controlling for age, Charlson Score, region, payor, and procedure type evaluated the association between preoperative anemia and risk of transfusion. Results: 44,989 patients met selection criteria; mean age was 64 years and 59% were female. Overall, 85.7% of patients were preoperatively classified as non-anemic, 11.0% were anemic, and 3.3% severely anemic. Anemia category did not change over time, with 13% of patients categorized as anemic or severely anemic from 2007 to 2017. Incidence of transfusion increased from 7.1% (no anemia) to 19.9% (anemia) and 33.2% (severe anemia; P< .001). In adjusted analysis, the odds of transfusion ranged from 3.13 (anemia, 95% CI 2.88-3.40) to 6.43 (severe anemia, 95% CI 5.70-7.24) relative to normal Hgb levels. cOnclusiOns: Despite increased focus on preoperative patient optimization, there remains a significant proportion of patients undergoing TJA with anemia, where preoperative Hgb is strongly associated with risk of transfusion. This study suggests a need for increased efforts to reduce anemia prior to surgery, and for patients where Hgb may not be optimized, advanced strategies for intraoperative blood management should be employed.

Trunk muscular endurance, lumbar spine mobility and hip flexibility in sailors with and without low back pain

“…Low back pain (LBP) is a worldwide problem [1,2], affecting athletes in a wide range of sports [2 -4]. Recent studies have shown that the prevalence of LBP in athletes varies by sport [4].…”