Immediate and Long-Term Outcomes Following Orthopedic Procedures in Patients with Hemophilia: A Three-Decade Retrospective Review
Notice bibliographique
Résumé
Introduction: Patients with hemophilia are at risk for developing hemophilic arthropathy and may require orthopedic interventions at a young age. It is unclear whether the advent of routine prophylaxis and comprehensive care have reduced the rates of orthopedic procedures in the past several decades, and whether improved supportive care have reduced perioperative complications. Aim: In this study, we aim to evaluate the overall trends of orthopedic procedures, surgical outcomes and healthcare utilization in patients with hemophilia who underwent orthopedic procedure in the past three decades. Methods: In this single-centre retrospective cohort study, adult patients with all severities of hemophilia who underwent at least one orthopedic procedure from January 1990-August 2018 at the University of Alberta Hospital were included. Demographic data, hemophilia history, details of orthopedic procedure, perioperative factor administration were collected. Temporal changes in the types of procedures, factor utilization, and outcomes were examined using descriptive analyses. Results: In the last 3 decades, 17 patients underwent 50 orthopedic procedures in our institution, including total knee arthroplasty (TKA) (n=18), TKA revision (n=8), total hip arthroplasty (n=5), ankle fusion (n=5), synovectomy (n=4), and others (n=10). Median age at the time of the procedure was 41 years (interquartile range IQR 31-48), and median BMI was 25 (IQR 22-39) (Table 1). Fourteen patients have hemophilia A and 3 have hemophilia B, including severe hemophilia in 13 (76%). Four patients (24%) have active inhibitors at the time of surgery. Ten (59%) patients had active hepatitis C infection at the time of surgery, whereas none had HIV infection. There is a reduction in the number of orthopedic surgeries performed over time (Table 2). There was a significant reduction in the length of stay from 1990-2000 to 2001-2018 (median 20 days vs 6 days, P <0.001). Overall perioperative coagulation factor concentrates were prescribed for a median of 10 days (IQR 7-20), whereas active inhibitor patients received bypassing agent coverage for a longer duration (median 17 days, IQR 10-21). There was a significant reduction in the perioperative factor VIII utilization over time (P=0.02), and a similar trend in factor IX utilization (Table 2). Tranexamic acid was used perioperatively in the majority (68%) of procedures for a median of 10 days. Pharmacologic thromboprophylaxis was prescribed in 15 (30%) procedures for a median of 8 days (IQR 7-13), intermittent pneumatic device was prescribed in 2, the remaining procedures had no documented thromboprophylaxis. Postoperative complications include major bleeding (n=2) and clinically relevant non-major bleeding (n=6), prosthetic joint infection (n=10), aseptic loosening requiring revision (n=2), poor wound healing complicated by skin necrosis (n=2), and deep vein thrombosis (n=1). The 10 infectious complications occurred in 6 patients, including early prosthetic joint infection <4 weeks in 6 cases, despite common use of prophylactic antibiotics in 92% of all cases. Pharmacological thromboprophylaxis was not associated with an increased risk of bleeding. There were no inhibitor development or arterial thromboses perioperatively. All complications occurred in surgeries performed prior to 2011. Conclusions: Over the past three decades, we observe a decline in the number of orthopedic procedures performed in patients with hemophilia, likely reflecting the impact of routine prophylaxis and changes in practice patterns. Orthopedic outcomes have improved over time, in conjunction with a reduction in healthcare utilization including shorter length of stay and reduced factor utilization. Disclosures Sun: Octapharma: Consultancy, Research Funding; Novo Nordisk: Consultancy.
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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 | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,005 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 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 ».