A BLOOD-CONSERVATION ALGORITHM TO REDUCE BLOOD TRANSFUSIONS AFTER TOTAL HIP AND KNEE ARTHROPLASTY

Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

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Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty

Journal of Personalized Medicine ◽

10.3390/jpm11111223 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1223

Author(s):

Axel Jakuscheit ◽

Nina Schaefer ◽

Johannes Roedig ◽

Martin Luedemann ◽

Sebastian Philipp von Hertzberg-Boelch ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Transfusion ◽

Knee Arthroplasty ◽

Haemoglobin Concentration ◽

Blood Transfusions ◽

Preoperative Treatment ◽

Complication Rates ◽

Total Hip ◽

Hip And Knee Arthroplasty ◽

Low Bmi

Background: The primary aim of this study was to identify modifiable patient-related predictors of blood transfusions and perioperative complications in total hip and knee arthroplasty. Individual predictor-adjusted risks can be used to define preoperative treatment thresholds. Methods: We performed this retrospective monocentric study in orthopaedic patients who underwent primary total knee or hip arthroplasty. Multivariate logistic regression models were used to assess the predictive value of patient-related characteristics. Predictor-adjusted individual risks of blood transfusions and the occurrence of any perioperative adverse event were calculated for potentially modifiable risk factors. Results: 3754 patients were included in this study. The overall blood transfusion and complication rates were 4.8% and 6.4%, respectively. Haemoglobin concentration (Hb, p < 0.001), low body mass index (BMI, p < 0.001) and estimated glomerular filtration rate (eGFR, p = 0.004) were the strongest potentially modifiable predictors of a blood transfusion. EGFR (p = 0.001) was the strongest potentially modifiable predictor of a complication. Predictor-adjusted risks of blood transfusions and acute postoperative complications were calculated for Hb and eGFR. Hb = 12.5 g/dL, BMI = 17.6 kg/m2, and eGFR = 54 min/mL were associated, respectively, with a 10% risk of a blood transfusion, eGFR = 59 mL/min was associated with a 10% risk of a complication. Conclusion: The individual risks for blood transfusions and acute postoperative complications are strongly increased in patients with a low preoperative Hb, low BMI or low eGFR. We recommend aiming at a preoperative Hb ≥ 13g/dL, an eGFR ≥ 60 mL/min and to avoid a low BMI. Future studies must show if a preoperative increase of eGFR and BMI is feasible and truly beneficial.

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VTE Prevention Following Total Hip and Knee Arthroplasty

Case Medical Research ◽

10.31525/ct1-nct04075240 ◽

2019 ◽

Author(s):

Keyword(s):

Knee Arthroplasty ◽

Total Hip ◽

Hip And Knee Arthroplasty

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Faculty Opinions recommendation of Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725263714.793502458 ◽

2014 ◽

Author(s):

Davide Cattano

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Knee Arthroplasty ◽

Complication Rates ◽

Total Hip ◽

Hip And Knee Arthroplasty ◽

Incidence Risk

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Faculty Opinions recommendation of The Effect of Smoking on Short-Term Complications Following Total Hip and Knee Arthroplasty.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725610223.793508963 ◽

2015 ◽

Author(s):

Edilson Forlin

Keyword(s):

Knee Arthroplasty ◽

Short Term ◽

Total Hip ◽

Hip And Knee Arthroplasty

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Predictors of Successful Early Discharge for Total Hip and Knee Arthroplasty in Octogenarians

HSS Journal ® ◽

10.1177/15563316211030631 ◽

2021 ◽

pp. 155633162110306

Author(s):

Andrew B. Kay ◽

Danielle Y. Ponzio ◽

Courtney D. Bell ◽

Fabio Orozco ◽

Zachary D. Post ◽

...

Keyword(s):

Range Of Motion ◽

Knee Arthroplasty ◽

Early Discharge ◽

Readmission Rates ◽

Patients Âgés ◽

Total Hip ◽

Hip And Knee Arthroplasty ◽

Student’S T ◽

American Society ◽

American Society Of Anesthesiologists

Background: Decreased length of stay after total joint arthroplasty (TJA) is becoming a more common way to contain healthcare costs and increase patient satisfaction. There is little evidence to support “early” discharge in elderly patients. Purpose: We sought to identify preoperative factors that correlated with early discharge (by postoperative day [POD] 1) in comparison to late discharge (after POD2) in octogenarians after TJA. Methods: In a retrospective cohort study from a single institution, we identified 482 patients ages 80 to 89 who underwent primary TJA from January 2014 to December 2017; 319 had total knee arthroplasty (TKA) and 163 had total hip arthroplasty (THA). Data collected included preoperative knee range of motion (ROM), demographics, and comorbidities; 90-day readmission and mortality rates were also evaluated. P values for continuous data were calculated using student’s t test and for categorical data using χ2 testing. Results: Of octogenarian patients, 30.9% were discharged by POD1. Early discharge was associated with being male, married, and nonsmoking, as well as having an American Society of Anesthesiologists (ASA) score of 2, independent preoperative ambulation, and a postoperative caregiver. Type of procedure (TKA vs THA), body mass index, laterality, preoperative range of motion (ROM) for TKA, and single vs multilevel home did not affect the probability of early discharge. Discharge on POD1 was not associated with increased 90-day readmission rates. There were no deaths. Conclusion: Early discharge for octogenarians can be successfully implemented in a select subset of patients without increasing 90-day readmission or death rates. There are multiple factors that predict successful early discharge.

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