The serum albumin threshold for increased perioperative complications after total hip arthroplasty is 3.0 g/dL

2018 ◽  
Vol 29 (2) ◽  
pp. 166-171 ◽  
Author(s):  
Charles L Nelson ◽  
Atul F Kamath ◽  
Nabil M Elkassabany ◽  
Zhenggang Guo ◽  
Jiabin Liu
Keyword(s):  
Total Hip Arthroplasty ◽  
Serum Albumin ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Albumin Level ◽  
Multivariable Logistic Regression Analysis ◽  
Study Cohort ◽  
Odds Ratios ◽  
Total Hip ◽  
Low Serum

Introduction: Low serum albumin is associated with higher perioperative complications following total hip arthroplasty (THA). The distinct threshold for a significant rise in perioperative complications has not been defined for THA. The purpose of this study was to define the threshold at which perioperative complications rise after THA. Methods: We analysed the American College of Surgeons NSQIP database from 2006 to 2013. Our study cohort included unilateral primary THA with reported preoperative albumin levels. Patients were stratified by albumin level. We analysed mortality and 6 composite complication variables (any complication, any complication without transfusion, wound infection, systemic infection, cardiac/pulmonary complications, and any major complication). All data analysis was executed in STATA statistical software. Multivariable logistic regression analysis was used to adjust for odds ratios. Results: The final cohort included 24,586 patients who were stratified based upon serum albumin levels. Odds ratios after multivariable regression adjustment for age, gender, race, body mass index, ASA classification, and Charlson Comorbidity Index indicated a trend to elevated odds of complication for all composite complications (3 of which were statistically significant) when serum albumin level was <3.0 g/dL. Conclusion: Low serum albumin is associated with increased perioperative complications following THA. The threshold associated with an increase in major perioperative complications appears to be an albumin level of <3.0 g/dL. With attempts to correct modifiable risk factors prior to surgery, the threshold value at which perioperative complications increase is important to define.

scholarly journals Diagnostic Potential of Low Serum Platelet, Albumin and Prolong PT-INR for Overactive Bladder and Nocturia in Chronic Hepatitis-Related Liver Cirrhosis

2021 ◽  
Vol 10 (13) ◽  
pp. 2838
Author(s):  
Po-Heng Chuang ◽  
Yi-Huei Chang ◽  
Po-Jen Hsiao ◽  
Eric Chieh-Lung Chou
Keyword(s):  
Liver Cirrhosis ◽  
Overactive Bladder ◽  
Serum Albumin ◽  
Urge Incontinence ◽  
Albumin Level ◽  
Chronic Viral Hepatitis ◽  
Study Cohort ◽  
Diagnostic Potential ◽  
Fluid Redistribution ◽  
Low Serum

Overactive bladder (OAB) is defined as urgency, usually with frequency, nocturia, and incontinence. Patients with liver cirrhosis often present with urinary complaints. The possible reason for this is fluid redistribution, which may induce OAB resulting from portal hypertension and ascites. We conducted this study to investigate predictors of OAB in cirrhotic patients. A total of 164 patients with chronic viral hepatitis-related liver cirrhosis were enrolled and 158 (96.3%) completed the Overactive Bladder Symptoms Score (OABSS) questionnaire. Age, severity of liver cirrhosis, comorbidities, serum sodium level, use of diuretics, body mass index and renal function were also recorded. In the study cohort, the prevalence of OAB was 31.01% and the prevalence of urge incontinence (OAB wet) was 18.3%. Patients with an urgency score ≥2 in OABSS had a significantly lower platelet level (p = 0.025) regardless of the use of diuretics. In addition, 98 patients (62%) with nocturia and 29 patients (18%) with urge incontinence had significantly lower levels of serum albumin (p = 0.028 and 0.044, respectively). In conclusion, patients with liver cirrhosis have a high prevalence of overactive bladder. A low platelet and low serum albumin level in these patients may be predictors for overactive bladder. And longer PT-INR is also a possible biomarker for nocturia.

Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications

2018 ◽  
Vol 33 (8) ◽  
pp. 2405-2411 ◽  
Author(s):  
Sean P. Ryan ◽  
Marcus DiLallo ◽  
David E. Attarian ◽  
William A. Jiranek ◽  
Thorsten M. Seyler
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Cost Of Care ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

scholarly journals Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jingyang Sun ◽  
Bohan Zhang ◽  
Lei Geng ◽  
Qingyuan Zheng ◽  
Juncheng Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Influencing Factors ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Femoral Stem ◽  
Femoral Anteversion ◽  
Total Hip

Abstract Background Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. Methods We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10–30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. Results After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, −9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. Conclusions This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.

scholarly journals Comparison of Combined Lumbosacral Plexus and T12 Paravertebral Nerve Blocks With General Anesthesia in Older Adults Undergoing Primary Total Hip Arthroplasty: A Retrospective, Propensity Score–Matched Cohort Study

2020 ◽  
Vol 11 ◽  
pp. 215145932097653
Author(s):  
Li Min ◽  
Chen Chen ◽  
Yuan Yan ◽  
Shen Jiang ◽  
Yang Linyi ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Propensity Score ◽  
General Anesthesia ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Lumbosacral Plexus ◽  
Cardiac Events ◽  
Nerve Blocks ◽  
Total Hip ◽  
Hip Disease

Background: Total Hip Arthroplasty(THA) is a surgical treatment for hip disease. A large amount of evidence has been reported on comparing outcomes of neuraxial(spinal or epidural) anesthesia and general anesthesia. However, it is unclear whether nerve blocks(NB) as main anesthesia technique compared with general anesthesia(GA) for THA could reduce perioperative complications. We conducted a retrospective evaluation of NB and GA, using a propensity score-matched analysis(PSMA). Methods: A total of 902 patients older than 60 years old with hip disease undergoing primary THA received combined lumbosacral plexus and T12 paravertebral nerve blocks (n = 143) or GA (n = 759) at our institution from 2012 to 2018.Binary logistic regression was used for comparison of the primary outcomes(the incidence of delirium) and the secondary outcomes(the percentage of postoperative hemoglobin(>10g/dl), transfusion(>2 units), major cardiac events(MACE), postoperative pulmonary complications (PPC) and 30-day mortality) in the matched cohorts.Statistical analysis was performed using SPSS v 23.0. Results: Both cohorts were balanced in all included parameters after PSMA. The incidence of delirium was lower (OR 0.233,95% CI 0.064-0.845, p = 0.030) in NB group in matched cohorts. In the unmatched and matched cohorts, the percentage of Hb(>10g/dl) was higher in GA group but the incidence of transfusion(>2 units) was higher in NB group. No difference was found in the incidence of 30-day mortality in the unmatched and matched cohorts. In the unmatched cohorts, the incidence of PPC was higher and LOS was longer in NB cohort, but no difference was observed in the matched cohorts. Conclusion: In patients older than 60 years old receiving primary THA, NB could be associated with a lower incidence of delirium.

scholarly journals Malnutrition as predictor of poor outcome after total hip arthroplasty

2020 ◽  
Author(s):  
Sandra Eminovic ◽  
Gabor Vincze ◽  
Doris Eglseer ◽  
Regina Riedl ◽  
Patrick Sadoghi ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Serum Albumin ◽  
Hip Arthroplasty ◽  
Nutritional Assessment ◽  
Demographic Data ◽  
Protein Energy Malnutrition ◽  
The Elderly ◽  
Clinical Markers ◽  
Total Hip ◽  
Operative Outcome

Abstract Introduction The aim of this study was to assess the prevalence of protein energy malnutrition (PEM) and correlation with poor post-operative outcome in the elderly undergoing primary total hip arthroplasty (THA). Hypothesis Patients with PEM would have inferior post-operative outcome after THA. Materials and method We retrospectively evaluated the nutritional status of 220 hospitalized patients undergoing THA, 65 years and older. PEM was assessed using serum albumin and total lymphocyte count (TLC). Studied outcome parameters were length of pre-operative and post-operative stay, complications up to six months after surgery and 12-month mortality. Clinical and demographic data were retrieved from medical records from the hospital database. Results The prevalence of PEM among patients undergoing THA was 12.3% (27/220). Patients with PEM were significantly older (mean age 81.3 ± 7.0, p < 0.001), had a lower BMI (24.7 ± 4.1 kg/m 2, p = 0.022), and showed more comorbid conditions (mean CCI 2.8 ± 2.0, p = 0.002) compared with well-nourished patients (age 75.6 ± 6.2, BMI 26.8 ± 4.3 kg/m 2, CCI: 1.7 ± 1.7). Length of pre-operative stay differed significantly (p < 0.001) between PEM (median 7, range 1–36 days) and non PEM (median 1, range 1–22 days). In the PEM group, 12 (44.4%) patients had post-operative complications within six months after OP and 15 (7.8%) patients in the non PEM group (HR = 6.3, 95% CI 1.7–23.1). Conclusion We observed a higher post-operative complication rate for malnourished patients undergoing elective THA. These results underline the importance of pre-operative nutritional assessment in the elderly. Therefore, serum albumin and TLC are valuable clinical markers of PEM and the post-operative outcome.

scholarly journals Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xingming Xu ◽  
Jiang Jiang ◽  
Wei Liu ◽  
Xiaofeng Li ◽  
Huading Lu
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Control Groups ◽  
Total Blood ◽  
Total Hip ◽  
Coagulation Function ◽  
And Control

Abstract Background Tranexamic acid (TXA) is widely used to reduce blood loss and transfusion rates in total hip arthroplasty(THA). Thromboelastography, which can monitor coagulation changes from clotting to fibrinolysis dynamically. In this study, thromboelastography was used to assess the dynamic changes in the coagulation of patients who underwent THA with the administration of TXA. Methods This randomized controlled trial consisted of 207 consecutive patients who underwent primary total hip arthroplasty. Patients were randomized into three groups: topical-TXA group received a topical application of TXA, IV-TXA group received an intravenous injection of TXA, and control group. Thromboelastography was performed 1 day before surgery and first, fourth, seventh days after surgery. The primary outcomes were thromboelastography parameters, the rates of deep vein thrombosis(DVT), and pulmonary embolism(PE). Secondary outcomes included perioperative blood loss, transfusion rates, and other perioperative complications. Results The mean calculated total blood loss in the Topical-TXA group were 832.7 ± 279.84 ml and 834.8 ± 322.94 ml in the IV-TXA group, which were significantly reduced (p < 0.05) compared with control groups at 1093.3 ± 379.7 ml. There were no significant differences between topical-TXA and IV-TXA groups in total blood loss or transfusion rates. K and R have reached a nadir from preoperative levels to 4th day postoperatively and then began to increase.α angle and CI peaked from preoperative levels to the fourth day postoperatively and then began to decline.IV-TXA significantly (p < 0.05) promoted coagulation levels compared with topical-TXA and control groups in the early postoperative period. Almost no significant differences were observed between topical-TXA and control groups in thromboelastography parameters.No significant differences were observed in the incidence of thromboembolic complications and other perioperative complications. Conclusions The topical administration of TXA had the same hemostatic effect as intravenous injection tranexamic acid. Coagulation function peaked on 4th day postoperatively and then began to decline. IV-TXA was more enhanced coagulation functions compared with topical-TXA.

Total Hip Arthroplasty after Vascularized Fibular Grafting

2012 ◽  
Vol 2 (1) ◽  
pp. 12-17
Author(s):  
Thomas P Vail ◽  
Apostolos Dimitroulias ◽  
Jeff Hodrick ◽  
Rusty Brand ◽  
Nicholas Viens ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Harris Hip Score ◽  
Control Group ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty ◽  
Significant Difference ◽  
Fibular Grafting

ABSTRACT Background Vascularized fibular grafting has been reported as a successful joint preserving surgery for patients with femoral head osteonecrosis. Few reports exist regarding the outcomes associated with total hip arthroplasty after failed vascularized fibular grafting. This study aims to highlight the early results and complications associated with this procedure. Materials and methods We retrospectively reviewed charts and radiographs of 30 patients (38 hips) who underwent conversion of prior vascularized fibular grafting to an uncemented total hip arthroplasty utilizing modern bearings (highly cross-linked polyethylene-on-metal or metal-on-metal). Mean follow-up was 41 months. A control group of 15 osteonecrosis patients (19 hips) was used who had a history of total hip arthroplasty without previous surgery. Outcome measures used were perioperative complications, clinical and radiological findings. Results The prior vascularized fibular grafting group had longer surgical times and more perioperative complications (calcar fracture and persistent wound drainage requiring early reoperation). In the prior vascularized fibular grafting group there were two cases requiring revision for aseptic loosening (one femoral and one acetabular component) and three cases of asymptomatic radiographic loosening (two femoral and one acetabular component). Furthermore, three patients reported symptoms of trochanteric bursitis. None of the above complications were seen in the control group. There was one dislocation in each group; and both were treated successfully with closed reduction. There was no significant difference between the two groups in the final postoperative Harris Hip Score (HHS). Conclusion Despite an increased complication rate, comparable clinical outcomes can be expected after conversion of vascularized fibular grafting to total hip arthroplasty. Dimitroulias A, Hodrick J, Brand R, Viens N, Attarian DE Vail TP, Bolognesi MP. Total Hip Arthroplasty after Vascularized Fibular Grafting. The Duke Orthop J 2012; 2(1):12-17.

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