Risk factors for blood transfusion and postoperative anaemia following total knee arthroplasty

医学 氨甲环酸 围手术期 置信区间 泊松回归 输血 相对风险 贫血 外科 回顾性队列研究 关节置换术 麻醉 内科学 失血 人口 环境卫生
作者
David A. Kolin,Peter K. Sculco,Alejandro González Della Valle,José A. Rodríguez,Michael P. Ast,Brian P. Chalmers
出处
期刊:The bone & joint journal [British Editorial Society of Bone & Joint Surgery]
卷期号:105-B (10): 1086-1093 被引量:13
标识
DOI:10.1302/0301-620x.105b10.bjj-2023-0030.r2
摘要

Blood transfusion and postoperative anaemia are complications of total knee arthroplasty (TKA) that are associated with substantial healthcare costs, morbidity, and mortality. There are few data from large datasets on the risk factors for these complications.We retrospectively reviewed the records of TKA patients from a single tertiary care institution from February 2016 to December 2020. There were a total of 14,901 patients in this cohort with a mean age of 67.9 years (SD 9.2), and 5,575 patients (37.4%) were male. Outcomes included perioperative blood transfusion and postoperative anaemia, defined a priori as haemoglobin level < 10 g/dl measured on the first day postoperatively. In order to establish a preoperative haemoglobin cutoff, we investigated a preoperative haemoglobin level that would limit transfusion likelihood to ≤ 1% (13 g/dl) and postoperative anaemia likelihood to 4.1%. Risk factors were assessed through multivariable Poisson regression modelling with robust error variance.In multivariable analyses, each gram of tranexamic acid reduced transfusion likelihood by 39% (adjusted risk ratio (ARR) 0.61 (95% confidence interval (CI) 0.47 to 0.78)). Risk factors associated with an increased risk of transfusion included operating time (ARR 2.07 (95% CI 1.54 to 2.77)) and drain use (ARR 1.73 (95% CI 1.34 to 2.24)).In this study, we found that increased tranexamic acid dosing, decreased operating time, and decreased drain use may reduce transfusions following TKA. We also established a single preoperative haemoglobin cutoff of 13 g/dl that could help minimize transfusions and reduce postoperative complete blood counts.
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