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

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...

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Autores principales:	Axel Jakuscheit, Nina Schaefer, Johannes Roedig, Martin Luedemann, Sebastian Philipp von Hertzberg-Boelch, Manuel Weissenberger, Karsten Schmidt, Boris Michael Holzapfel, Maximilian Rudert
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	patient blood management total joint arthroplasty haemoglobin perioperative management Medicine R
Acceso en línea:	https://doaj.org/article/3c1aa3e7161e402392a412412999162b
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spelling	oai:doaj.org-article:3c1aa3e7161e402392a412412999162b2021-11-25T18:08:08ZModifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty10.3390/jpm111112232075-4426https://doaj.org/article/3c1aa3e7161e402392a412412999162b2021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4426/11/11/1223https://doaj.org/toc/2075-4426Background: 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, <i>p</i> < 0.001), low body mass index (BMI, <i>p</i> < 0.001) and estimated glomerular filtration rate (eGFR, <i>p</i> = 0.004) were the strongest potentially modifiable predictors of a blood transfusion. EGFR (<i>p</i> = 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/m<sup>2</sup>, 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.Axel JakuscheitNina SchaeferJohannes RoedigMartin LuedemannSebastian Philipp von Hertzberg-BoelchManuel WeissenbergerKarsten SchmidtBoris Michael HolzapfelMaximilian RudertMDPI AGarticlepatient blood managementtotal joint arthroplastyhaemoglobinperioperative managementMedicineRENJournal of Personalized Medicine, Vol 11, Iss 1223, p 1223 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	patient blood management total joint arthroplasty haemoglobin perioperative management Medicine R
spellingShingle	patient blood management total joint arthroplasty haemoglobin perioperative management Medicine R Axel Jakuscheit Nina Schaefer Johannes Roedig Martin Luedemann Sebastian Philipp von Hertzberg-Boelch Manuel Weissenberger Karsten Schmidt Boris Michael Holzapfel Maximilian Rudert Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty
description	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, <i>p</i> < 0.001), low body mass index (BMI, <i>p</i> < 0.001) and estimated glomerular filtration rate (eGFR, <i>p</i> = 0.004) were the strongest potentially modifiable predictors of a blood transfusion. EGFR (<i>p</i> = 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/m<sup>2</sup>, 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.
format	article
author	Axel Jakuscheit Nina Schaefer Johannes Roedig Martin Luedemann Sebastian Philipp von Hertzberg-Boelch Manuel Weissenberger Karsten Schmidt Boris Michael Holzapfel Maximilian Rudert
author_facet	Axel Jakuscheit Nina Schaefer Johannes Roedig Martin Luedemann Sebastian Philipp von Hertzberg-Boelch Manuel Weissenberger Karsten Schmidt Boris Michael Holzapfel Maximilian Rudert
author_sort	Axel Jakuscheit
title	Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty
title_short	Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty
title_full	Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty
title_fullStr	Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty
title_full_unstemmed	Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty
title_sort	modifiable individual risks of perioperative blood transfusions and acute postoperative complications in total hip and knee arthroplasty
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/3c1aa3e7161e402392a412412999162b
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Modifiable Individual Risks of Perioperative Blood Transfusions and Acute Postoperative Complications in Total Hip and Knee Arthroplasty

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