Kapadia Bhaveen H, Boylan Matthew R, Elmallah Randa K, Krebs Viktor E, Paulino Carl B, Mont Michael A
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York; Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, New York.
J Arthroplasty. 2016 Jul;31(7):1578-82. doi: 10.1016/j.arth.2016.01.012. Epub 2016 Jan 21.
Hemophilia can lead to the development of arthropathies secondary to recurrent hemarthroses. However, given these patients' bleeding tendencies, postoperative complications associated with blood loss are a considerable concern.
We identified men in the Nationwide Inpatient Sample who underwent total hip or knee arthroplasty between January 1998 and December 2010. We used propensity scores to match 332 hemophiliacs (267 hemophilia A, 65 hemophilia B) to a comparison cohort of 996 patients in a 1:3 ratio, according to the site of arthroplasty, year of admission, age, race, and Charlson and Deyo score.
The incidence of any postoperative transfusion was 15.06% for hemophiliacs, compared with 9.84% for the matched comparison cohort (P = .012). For hemophiliacs, the odds ratio was 1.60 (95% confidence interval [CI] = 1.11-2.31; P = .013) for any transfusion, 1.90 (95% CI = 1.24-2.92; P = .003) for allogenic transfusion, and 1.05 (95% CI = 0.56-1.95; P = .888) for autogenic transfusion.
Hemophilia is associated with an increased risk of blood transfusion after lower extremity total joint arthroplasty. Patients and providers should discuss these risks before surgery, and insurers should consider incorporating this comorbidity into bundled payments for total hip and knee arthroplasty.
血友病可导致继发于反复关节积血的关节病。然而，鉴于这些患者的出血倾向，与失血相关的术后并发症是一个相当大的问题。
我们在全国住院患者样本中确定了1998年1月至2010年12月期间接受全髋关节或膝关节置换术的男性。我们根据置换部位、入院年份、年龄、种族以及Charlson和Deyo评分，使用倾向评分以1:3的比例将332名血友病患者（267名甲型血友病患者，65名乙型血友病患者）与996名患者的对照队列进行匹配。
血友病患者术后任何输血的发生率为15.06%，而匹配的对照队列中这一比例为9.84%（P = .012）。对于血友病患者，任何输血的比值比为1.60（95%置信区间[CI] = 1.11 - 2.31；P = .013），异体输血的比值比为1.90（95% CI = 1.24 - 2.92；P = .003），自体输血的比值比为1.05（95% CI = 0.56 - 1.95；P = .888）。
血友病与下肢全关节置换术后输血风险增加相关。患者和医疗服务提供者应在手术前讨论这些风险，保险公司应考虑将这种合并症纳入全髋关节和膝关节置换术的捆绑支付中。
