Postoperative Blood Use Following Elective Total Hip and Total Knee Arthroplasty
Notice bibliographique
Résumé
Abstract Abstract 1181 Use of allogeneic blood in elective procedures should be minimized due to risks of transfusion, potential adverse impact on outcomes, inconvenience to the patient, high cost and limited supply of blood. The purpose of this study was to examine the rate of transfusion following elective total hip (THA) and total knee arthroplasties (TKA) within a preoperative and perioperative blood management program and to examine the relationship between clinical and surgical parameters and blood transfusion. Methods: This was a secondary analysis of prospectively collected data of all consented patients who had undergone joint arthroplasty surgery between January and December, 2011. All patients attended a preoperative clinic 7–14 days prior to their surgery. The preoperative hemoglobin (Hgb) was measured. Transfusion rate was calculated for type of surgery (primary vs. revision and unilateral vs. bilateral). Impact of preoperative Hgb, age, sex, Body Mass Index (BMI), estimated blood loss, type of anaesthetic, type of anticoagulant (rivaroxaban vs. no rivaroxaban), surgeon and drop in hemoglobin (preoperative hemoglobin minus lowest post-operative hemoglobin documented on postoperative day 1, 2 or 3) were examined. Descriptive statistics examined the rate of transfusion in different procedures. Univariate analysis examined the relationship between each factor and having a transfusion. Stepwise logistic regression examined the impact of all factors together. Statistical significance was set at p<0.05. Results: 1605 patients [989 females (62%), mean age 66 (SD:11)] had surgery during 2011. Primary TKA: Unilateral 821 (51%), Bilateral TKA: 41 (3%), Revision TKA: 91 (6%), Primary THA: 588 (37%), Bilateral THA: 4 (0.02%), Revision THA: 60 (4%). Four percent (4%) of females had an Hgb <120 mg/L and 3% of males had an Hgb <130 mg/L at the preoperative visit. There were 1555 cases done under regional anaesthesia (spinal or epidural) and 129 cases received a general anaesthetic. Sixty-seven patients (4%) had a blood transfusion while in hospital. Thirty percent (30%) of the transfused women and 9% of the men had a low pre-operative Hgb. THA procedures required more transfusions than TKA (p=0.0012). Transfusion was associated with the following individual factors: age ≥ 80 years, female sex, low BMI (<18.5), increased estimated blood loss, larger drop in hemoglobin, type of anticoagulant (4% in rivaroxaban vs. 8% in non-rivaroxaban), revision surgery (vs. primary), simultaneous bilateral arthroplasty, general anesthesia (vs. spinal), and surgeon. Stepwise logistic regression analysis maintained the intra-operative blood loss, drop in Hgb, female sex, and age as significant independent factors in explaining the variation in blood transfusion. Discussion: This study was carried out in an independent orthopaedic facility for elective joint surgery. All patients are assessed medically prior to surgery and advised to take supplemental iron for 2 months prior to surgery. Four percent of females and 3% of males were found to be anemic preoperatively. Patients are admitted the morning of their surgery. Approximately 97% of the consented patients had a regional anesthetic (spinal and/or epidural) with sedation. Patients are transferred into the operating room after the anaesthetic was administered. Surgery is carried out without the routine use of cell saver, tranexamic acid or drains. Approximately 50% of the surgeons deflate the tourniquet in a total knee arthroplasty prior to closure of the capsule. Thromboprophylaxis is initiated with rivaroxaban 10 mg on postoperative day 1. The general transfusion trigger for symptomatic patients is a hemoglobin of 80 g/L. Transfusions can be ordered by staff surgeon, hospitalist, medical consultant or Orthopaedic fellow. The blood bank does not group and screen patients scheduled for routine primary total hip or total knee arthroplasty. Following these practices, we observed a transfusion rate for primary THA of 5% and primary TKA of 3% while using rivaroxaban for thromboprophylaxis starting on postoperative day 1. Conclusion: The present study confirmed that intra-operative blood loss, drop in the hemoglobin, being a female, and older than 80 years of age as risk factors in relation to need for blood transfusion following elective total joint arthroplasty. Transfusion rates were not higher when rivaroxaban was used for thromboprophylaxis. Disclosures: Murnaghan: Bayer Healthcare: Honoraria, Research Funding. Off Label Use: Rivaroxaban was used perioperatively for thromboprophylaxis. Our protocol gave the intial dose on postoperative day 1 rather than the 6–10 hours post-operatively recommended by the manufacturer in product monograph. Gollish:Bayer Healthcare: Honoraria, Research Funding.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».