Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective

2017 ◽  
Vol 45 (7) ◽  
pp. 1640-1644 ◽  
Author(s):  
Samuel A. Taylor ◽  
Ryan M. Degen ◽  
Alexander E. White ◽  
Moira M. McCarthy ◽  
Lawrence V. Gulotta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Revision Surgery ◽  
Significant Risk ◽  
Biceps Tenodesis ◽  
Time Of Surgery ◽  
Slap Repair ◽  
Long Head ◽  
Slap Tear ◽  
Anterior Posterior

Background: Data regarding risk factors for revision surgery after superior labral anterior-posterior (SLAP) repair are limited to institutional series. Purpose: To define risk factors for revision surgery after SLAP repair among patients in a large national database. Study Design: Case-control study; Level of evidence, 3. Methods: A national insurance database was queried for patients undergoing arthroscopic SLAP repair (Current Procedural Terminology [CPT] code 29807) for the diagnosis of a SLAP tear. Patients without a CPT modifier for laterality were excluded. Revision surgery was defined as (1) subsequent ipsilateral SLAP repair (CPT 29807), (2) ipsilateral arthroscopic debridement for the diagnosis of a SLAP tear (CPT 29822 or 29823, with diagnosis code 840.7), (3) subsequent ipsilateral arthroscopic biceps tenodesis (CPT 29828), (4) subsequent ipsilateral open biceps tenodesis (CPT 23430), and (5) subsequent biceps tenotomy (CPT 23405). Multivariable binomial logistic regression analysis was performed to identify risk factors for revision surgery after SLAP repair, including patient demographics/comorbidities, concomitant diagnoses, and concomitant procedures performed. Odds ratios (ORs), 95% CIs, and P values were calculated. The estimated financial impact of revision surgery was also calculated. Results: There were 4751 patients who met inclusion and exclusion criteria. Overall, 121 patients (2.5%) required revision surgery after SLAP repair. Regression analysis identified numerous risk factors for revision surgery, including age >40 years (OR, 1.5; 95% CI, 1.2-1.8; P = .045), female sex (OR, 1.5; 95% CI, 1.3-1.8; P = .010), obesity (OR, 1.8; 95% CI, 1.5-2.2; P = .001), smoking (OR, 2.0; 95% CI, 1.6-2.4; P < .0001), and diagnosis of biceps tendinitis (OR, 3.5; 95% CI, 3.0-4.2; P < .0001) or long head of the biceps tearing (OR, 5.1; 95% CI, 4.1-6.3; P < .0001) at or before the time of surgery. Concomitant rotator cuff repair and distal clavicle excision were not significant risk factors for revision surgery. The cost of revision surgery averaged almost $9000. Conclusion: Risk factors for revision surgery after SLAP repair include age >40 years, female sex, obesity, smoking, and diagnosis of biceps tendinitis or long head of the biceps tearing. The diagnosis of biceps tendinitis (OR, 3.5) or long head of the biceps tearing (OR, 5.1) at or before the time of surgery was an especially significant risk factor for revision surgery. The high cost of revision surgery highlights the importance of appropriate indications to avoid the need for subsequent procedures.

Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the Overhead Athlete: A Systematic Review

2020 ◽  
pp. 036354652092117 ◽  
Author(s):  
Travis L. Frantz ◽  
Andrew G. Shacklett ◽  
Adam S. Martin ◽  
Jonathan D. Barlow ◽  
Grant L. Jones ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Return To Sports ◽  
Biceps Tenodesis ◽  
Inclusion Criteria ◽  
Overhead Athletes ◽  
Overhead Athlete ◽  
Slap Repair ◽  
Slap Tear ◽  
Anterior Posterior

Background: Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years. Purpose: To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear. Study Design: Systematic review. Methods: A systematic review was performed for any articles published before July 2019. The search phrase “labral tear” was used to capture maximum results, followed by keyword inclusion of “SLAP tear” and “biceps tenodesis.” Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined. Results: After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals. Conclusion: BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.

scholarly journals Abdominal Wall Injuries at the Elite Level in Australian Male Professional Cricketers

2015 ◽  
Vol 49 (4) ◽  
pp. 155-158 ◽  
Author(s):  
David Humphries ◽  
John Orchard ◽  
Alex Kountouris
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Abdominal Wall ◽  
Data Extraction ◽  
Statistical Significance ◽  
Significant Risk ◽  
Oblique Muscle ◽  
Minimal Risk ◽  
Risk Increase ◽  
Elite Level

ABSTRACT Background Injuries to the abdominal wall, particularly muscular injuries, are relatively common in professional cricketers. The Cricket Australia injury database holds data on these injuries over a 20 years span. Methods This study is a combination of (1) a descriptive outline of the parameters associated with side strains and abdominal wall injuries in elite male cricketers, based on deidentified data extraction from the Cricket Australia database from 1995 to 1996 and 2014 to 2015; (2) multivariate regression analysis of risk factors for abdominal wall strains, taking into account the risk factors of player position, player age and previous abdominal wall injury history. Results There were 183 injuries recorded over a 20 years period at Australian state or national player level. Significant risk factors in logistic regression analysis were: being a Pace Bowler RR 10.0 (95% CI 3.1—32.1) and being 24 years old or younger RR 3.4 (95% CI 1.7—6.8). Surprisingly, there was only minimal risk increase, not reaching statistical significance, for recent injury in the same season (p = 0.18) and no association at all with past injury in previous season (p = 0.99). Discussion The internal oblique muscle is reported the most commonly injured component of the abdominal wall, the injuries are overwhelmingly sustained by pace bowlers and the peak incidence of the injury is in the early part of the cricket season. Younger fast bowlers are more likely to be injured than older ones. A history of abdominal wall strain in either the recent or distant past does not increase or decrease future risk of strain, which is in contrast to other muscle strains. How to cite this article Humphries D, Orchard J, Kountouris A. Abdominal Wall Injuries at the Elite Level in Australian Male Professional Cricketers. J Postgrad Med Edu Res 2015;49(4): 155-158.

scholarly journals Variability in Rehabilitation Protocols after Superior Labrum Anterior Posterior Surgical Repair

2021 ◽  
Vol 14 ◽  
pp. 243-248
Author(s):  
Christina Hermanns ◽  
Reed Coda ◽  
Sana Cheema ◽  
Matthew Vopat ◽  
Armin Tarakemeh ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Surgical Repair ◽  
Return To Sport ◽  
Return To Sports ◽  
Biceps Tenodesis ◽  
Slap Repair ◽  
Rehabilitation Protocols ◽  
Google Search ◽  
Improve Patient ◽  
Anterior Posterior

Introduction. Rehabilitation after a superior labral anterior posterior (SLAP) repair is an important aspect of patient outcomes, however, no standardized rehabilitation protocol has been defined. The purpose of this paper is to assess the variability of rehabilitation after SLAP repair to understand the need for standardization to improve patient outcomes. Methods. Protocols for SLAP repairs were collected through a search for Academic Orthopedic Programs and a general google search using the terms “[Program Name (if applicable)] SLAP Repair Rehab Protocol”. Protocols were compared by sling, range of motion (ROM), physical therapy, return to sport (RTS), return to throwing, and biceps engagement/ biceps tenodesis recommendations. Protocols for non-operative or generalized shoulders were excluded.  Results. Sixty protocols were included. A total of 61.7% (37/60) recommended a sling for four to six weeks and 90% (54/60) included a full ROM recommendation, but time was variable. There were different exercises recommended, but pendulum swings were recommended by 53% (32/60), submaximal isometrics by 55% (33/60), and scapular strengthening by 65% (39/60). Of the sixty protocols, 33% (20/60) recommended return to sports in 24 weeks and 38.3% (23/60) recommended allowing throwing in 16 weeks. Conclusion. There was variability in protocols for SLAP repair, especially time until full ROM, RTS, and biceps strengthening. Time in sling and scapular strengthening were the least variable. A lack of specificity within protocols in what return to throwing meant for functional ability made it difficult to compare protocols. Considering the large number of Orthopedic programs, a relatively small number had published protocols. Further studies are needed to evaluate a standardized post-operative rehabilitation for SLAP repairs to improve outcomes.

scholarly journals Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0031
Author(s):  
Justin W. Arner ◽  
Sachidhanand Jayakumar ◽  
Dharmesh Vyas ◽  
James P. Bradley
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Revision Surgery ◽  
Significant Risk ◽  
Return To Sport ◽  
Significant Risk Factor ◽  
Return To Play ◽  
Bone Width ◽  
Posterior Shoulder

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed. Methods: A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared. Results: Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p<0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p<0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041). Conclusion: Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.

Serious Symptomatic Thromboembolic Complications in Patients Undergoing Total Hip Replacement - A Prospective Study.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 630-630
Author(s):  
Camilla Ryge ◽  
Michael Rud Lassen ◽  
Soeren Solgaard ◽  
Stig Sonne-Holm
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Total Hip Replacement ◽  
Logistic Regression Analysis ◽  
Hip Replacement ◽  
Significant Risk ◽  
Vascular Events ◽  
Total Hip ◽  
Vein Thrombosis

Abstract Purpose: To describe the rate and time of onset of serious thromboembolic (TE) complications within the first 90 postoperative days in an unselected population of THR patients. Secondary to analyse the data base for possible risk factors of TE. Material and method: Five hundred (430 primary THR and 70 revision THR) consecutive patients undergoing THR in Frederiksborg County, Denmark from January 2004 until May 2005 participated. The patients were interviewed the day before surgery for medical history. On the 5th postoperative day and at a telephone interview 90 days postoperatively patients were asked about signs and symptoms of acute myocardial infarction (AMI), pulmonary embolism (PE), deep vein thrombosis (DVT), transitory cerebral ischemia (TCI)/stroke, retinal vein thrombosis (RVT) and other cardio vascular events. All events were validated in hospital and/or the general practitioners files, using international criteria. All patients except 1 had chemical thromboprophylaxis during hospitalization. No patients had extended thromboprophylaxis after discharge. 498 patients had 90 days follow-up. Two patients withdrew their consent. Results: 24 patients (4.8%) experienced at least one serious TE complication during the first 90 days after the operation. Two (0.4%) patients died in relation to the operation (no autopsy was performed). Five patients (1.0%) had PE. One patient (0.2%) had AMI, 10 (2.0%) had DVT, two (0.4%) had RVT and four (0.8%) had TCI. Two patients experienced two events - one had AMI and later on a TCI, another had PE and TCI on the same day. Nine patients had their first event during the first five postoperative days - 15 patients had their first event after the 5th postoperative day. The only significant risk factor found in a backward logistic regression analysis including interaction (test for confounder/bias) was the length of the operation P=0.003 OR= 1.016 (1.005–1.026). This study has not been able to show any significant correlation between age, gender, co-morbidities, preoperative hemoglobin value ore platelet count, high ASA-score, kind of anesthesia, indication for operation or use of cement or interactions between the above in the logistic regression analysis, but individually all these factors were significant risk factors in the introductory bivariate analysis. Discussion: This study shows that venous and arterial thrombotic complications persist to be a major contribution to postoperative morbidity and mortality after elective total hip replacement, despite of rigorous early mobilization and optimized regimens of prevention of thromboembolism. After this study has been performed ACCP has recommended extend prophylaxis by LMWH, pentasaccharide or warfarin up to 4–5 weeks after total hip replacement. Further research to identify patients at risk is warranted to optimize risk/benefit of total hip replacement and prevention of venous and arterial thromboembolism. The majority of events occurred after discharge calling for improvement of the post-discharge period to reduce the risk of serious thromboembolism.

Risk Factors for Silent Cerebral Infarcts in a Pediatric Sickle Cell Anemia (SCA) Cohort

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2487-2487 ◽  
Author(s):  
Francoise Bernaudin ◽  
Suzanne Verlhac ◽  
Annie Kamdem ◽  
Cécile Arnaud ◽  
Lena Coïc ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Risk Factor ◽  
Logistic Regression Analysis ◽  
G6pd Deficiency ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
History Of ◽  
Independent Risk Factors

Abstract Background Silent infarcts are associated with impaired cognitive functioning and have been shown to be predictors of stroke (Miller ST J Pediatr 2001). Until now, reported risk factors for silent infarcts were low pain event rate, history of seizures, high leukocyte count and Sen bS haplotype (Kinney TR Pediatrics 1999). Here, we seek to define the prevalence and risk factors of silent infarcts in the Créteil SCA pediatric cohort comprising patients assessed at least yearly by transcranial doppler (TCD) since 1992, and by MRI/MRA. Methods This study retrospectively analyzed data from the Créteil cohort stroke-free SS/Sb0 children (280; 134 F, 146 M), according to institutional review board. Time-averaged mean of maximum velocities higher than 200 cm/sec were considered as abnormal, resulting in initiation of a transfusion program (TP). A switch to hydroxyurea was proposed to patients with normalized velocities (&lt; 170 cm/sec) and normal MRA on TP, although TP was re-initiated in case of abnormal velocities recurrence. Patients with “conditional” velocities (170–199 cm/sec) were assessed by TCD 4 times yearly. Alpha genes and beta-globin haplotypes were determined. Baseline biological parameters (G6PD activity; WBC, PMN, Reticulocytes, Platelets counts; Hemoglobin, Hematocrit, HbF, LDH levels; MCV; SpO2) were obtained a minimum of 3 months away from a transfusion, one month from a painful episode, after 12 months of age, before the first TCD, and always before therapy intensification. Results. Patients were followed for a total of 2139 patient-years. Alpha-Thal was present in 114/254 patients (45%) and 27/241 (11.2%) had G6PD deficiency. Beta genotype, available in 240 patients, was BaBa in 102 (42.5%), BeBe in 54 (22.5%), SeSe in 19 (7.9%) and “other” in 65 (27.1%); TCD was abnormal in 52 of 280 patients (18.6%). MRA showed stenoses in 30 of 226 evaluated patients (13.3%) while MRI demonstrated presence of silent infarcts in 81/280 patients (28.9%). Abnormal TCD (p&lt;0.001), G6PD deficiency (p=0.008), high LDH (p=0.03), and low Hb (p=0.026) were significant risk factors for stenoses by univariate analysis while multivariate analysis retained only abnormal TCD as a significant risk factor for stenoses ([OR= 10.6, 95% CI (4.6–24.4)]; p&lt;0.001). Univariate logistic regression analysis showed that the risk of silent infarcts was not related to alpha-Thal, beta genotype, abnormal TCD, WBC, PMN, platelets, reticulocyte counts, MCV, LDH level, HbF %, pain or ACS rates but was significantly associated with stenoses detected by MRA (p&lt;0.001), gender (male; p=0.04), G6PD deficiency (p=0.05), low Hb (p=0.016) and Hct (p=0.012). Multivariate logistic regression analysis showed that gender ([OR= 2.1, 95% CI (1.03–4.27)]; p=0.042), low Hb ([OR= 1.4, 95% CI (1.0–1.1)]; p=0.05) and stenoses ([OR= 4.8, 95% CI (1.88–12.28)]; p=0.001) were all significant independent risk factors for silent infarcts. The presence of stenoses was the only significant risk factor for silent infarcts in patients with a history of abnormal TCD ([OR= 5.9, 95% CI (1.6–21.7)]; p=0.008). Conclusion We recently showed that G6PD deficiency, absence of alpha-Thal, and hemolysis are independent significant risk factors for abnormal TCD in stroke-free SCA patients (Bernaudin et al, Blood, 2008, in press). Here, we report that an abnormal TCD is the most significant risk factor for stenoses and, expanding previous studies, we demonstrate that stenoses, low Hb and gender are significant independent risk factors for silent infarcts.

scholarly journals Asthma and Keratoconus: An analysis of the risk factors association with the severity of keratoconus

2020 ◽  
Author(s):  
Srujana Sahebjada ◽  
Elsie Chan ◽  
Jing Xie ◽  
Grant Snibson ◽  
Mark Daniel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Educational Background ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Wide Range ◽  
Multivariable Regression

Abstract Background: A cross-sectional study was undertaken in Australia to explore a wide range of risk factors associated with keratoconus. A questionnaire addressing age, gender, educational background, ocular and medical history, smoking and alcohol consumption, and physical examination comprising anthropometric measurements was collected; eye examination was undertaken. The associations between a range of risk factors and keratoconus was determined using univariate and multivariable linear regression analyses.Main Text: A total of 260 keratoconus subjects were included in this study. Mean age of subject was 35.5 (SD= 14.8) years and the majority of the subjects were European 171 (68.2%). Initial univariate regression analysis identified the following risk factors at the p<0.1 level with keratoconus: higher body mass index, smoking cigarettes, diabetes, rheumatoid arthritis and asthma were associated with increased severity of keratoconus, whereas eczema was associated with less severe keratoconus. Following multivariable regression analysis, only asthma remained as a significant risk factor associated with 2.2 diopters (D) steeper average mean keratometry compared to keratoconus subjects having no asthma [p = 0.03; β= 2.18; 95% confidence intervals: 1.22, 4.14].Conclusion: Our study describes the comprehensive assessment of all the known risk factors in a large keratoconus cohort recruited in Australia. Our study has reported asthma as the only risk factor found to be significantly associated with keratoconus. The results of this study allow us to better understand the aetiology of keratoconus and such a knowledge could be useful in instigate systemic management of patients to slow or prevent keratoconus.

scholarly journals Associations of Serum MicroRNA with Bone Mineral Density in Community-Dwelling Subjects: The Yakumo Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Hiroaki Nakashima ◽  
Kei Ando ◽  
Kazuyoshi Kobayashi ◽  
Taisuke Seki ◽  
Shinya Ishizuka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Bone Mineral ◽  
Logistic Regression Analysis ◽  
Odds Ratio ◽  
Significant Risk ◽  
Mineral Density ◽  
Confidential Interval

Osteoporosis is a disease characterized by deterioration of bone tissue and mass, with an increasing global prevalence. Therefore, the discovery of biomarkers for osteoporosis would help to guide appropriate treatment. Circulating microRNAs (miRNAs) have become increasingly recognized as biomarkers for detecting diseases. However, few studies have investigated the association of circulating miRNA with osteoporosis in the general population. The aim of this study was to identify miRNA associated with osteoporosis in a general resident health check-up for potential use as an osteoporosis biomarker. We conducted a cross-sectional study as part of a health check-up program and recruited 352 volunteers (139 men, 213 women, mean age 64.1±9.6 years). Osteoporosis was diagnosed according to the WHO classification. Twenty-two candidate microRNAs were screened through real-time quantitative PCR, and miRNAs associated with osteoporosis were analyzed using logistic regression analysis including other risk factors. In total, 95 females and 30 males were diagnosed with osteoporosis with bone mineral density tests (BMD: T‐score<−2.5). We found that miR195 was significantly lower in females, while miR150 and miR222 were significantly higher in males. The results of the logistic regression analysis indicated that in females, higher age and lower miR195 (odds ratio: 0.45, 95% confidential interval: 0.03–0.98) were significant risk factors for lower BMD, while the presence of a smoking habit and lower miR150 (odds ratio: 1.35, 95% confidential interval: 1.02–1.79) were significant risk factors for osteoporosis. Serum levels of miR195 and miR150 are independently associated with low bone mineral density in females and males, respectively.

Risk factors for severe anemia requiring red blood cell transfusions in lymphoma patients receiving chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19537-19537
Author(s):  
X. Zhou ◽  
S. R. Teegala ◽  
A. Huen ◽  
Y. Ji ◽  
L. E. Fayad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
High Risk ◽  
Significant Risk ◽  
Baseline Risk ◽  
Severe Anemia ◽  
Nodal Involvement ◽  
Initial Regimen ◽  
Number Of Cycles

19537 Background: Anemia is a frequent complication in lymphoma pts receiving chemotherapy (CT). However, the exact incidence of anemia with the current regimens and risk factors for severe anemia are not well established. Methods: A retrospective cohort study was conducted to determine the incidence of anemia requiring transfusions (Tx). Medical records of all newly referred lymphoma pts (n=1046) in 2003 were reviewed. Logistic regression analysis was performed to identify the clinical and laboratory features correlated with anemia in lymphoma pts during initial regimen received. Results: 425 pts who received ≥ 1 cycle of treatment at MDACC were included in this analysis. Median age was 57 (range 17–87) with 262 (62%) newly diagnosed. Most common first regimens were CHOP (29%), Hyper-CVAD ± Ara-c-MTX (23%), and ABVD (8%) (± rituxan- R).The total number of cycles 1638 (median 3, range, 1–10). The incidence of anemia requiring PRBC Tx was 32 % (136/425) of pts and 14% (231/1638) of cycles (median cycle-2 for Tx). The incidence of PRBC Tx ranged from 8% to 17 % in each cycle. The incidence of PRBC Tx among most common regimens were Hyper-CVAD/ Ara-c/MTX 69 %( 66/95), CHOP 23% (29/125), and ABVD 6% (2/34). In the univariate regression analysis, CT, stage, extranodal/BM involvement, histology, Hb, Ca, β2M, LDH, WBC/lymphocyte counts, were significantly associated with the Txs. Using multivariate logistic regression, baseline Hb (< 12 g/dL vs. ≥ 12 g/dL: OR 2.659, 95% CI 1.670 to 4.232, p< 0.0001), extra nodal involvement (± : OR 2.578, 95% CI 1.609 to 4.133, p<0.0001), and CT (high vs low risk: OR 3.889, 95% CI 2.446 to 6.183, p<0.0001) were the most important baseline risk factors for PRBC Txs. Conclusions: The incidence of anemia in this population is high in early cycles. Baseline pt characteristics including Hb (<12g/dL), extra nodal involvement, and high risk CT were found to be significant risk factors predictive for anemia and Txs. These findings could be useful to identify high risk pts for consideration of prophylaxis with erythropoietic agents for prevention of anemia. No significant financial relationships to disclose.

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