Jans Øivind, Bandholm Thomas, Kurbegovic Sorel, Solgaard Søren, Kjaersgaard-Andersen Per, Johansson Pär I, Kehlet Henrik
Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital.
Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty, Cophenhagen, Denmark.
Transfusion. 2016 Apr;56(4):917-25. doi: 10.1111/trf.13508. Epub 2016 Mar 4.
Postoperative anemia is prevalent in fast-track hip arthroplasty (THA) where patients are mobilized and discharged early, but whether anemia impairs functional recovery after discharge has not been adequately evaluated previously. This study aimed to evaluate whether postoperative anemia influenced recovery of mobility and quality of life (Qol) during the first 2 weeks after discharge from THA.
This was a prospective observational study in 122 THA patients more than 65 years of age. Mobility and Qol were assessed pre- and postoperatively by the 6-minute walk test (6MWT; primary outcome), the timed up-and-go test, and the FACT-anemia subscale. Twenty-four-hour mobility at home was assessed by activity monitoring on Days 1 to 6 after discharge. Hemoglobin (Hb) at discharge (HbD) and the Hb decrease from preoperatively (ΔHb) were compared to mobility and Qol the first 2 weeks after discharge using bivariate and multivariate linear regression.
Mean (±SD) HbD and ΔHb values were 11.1 (±1.4) and 2.8 (±1.2) g/dL and correlated weakly to 6MWT 2 weeks after discharge (r = 0.23 and r = -0.20 respectively; p < 0.05) but HbD levels were not correlated to other mobility or Qol measures. After adjustment for preoperative patient-related factors, HbD explained 6% (95% confidence interval, 0%-9%; p < 0.05) of the variation in 6MWT recovery.
Despite a weak, but significant, correlation between postoperative Hb and the recovery of 6MWT, all other mobility and Qol measures were not influenced by postoperative Hb. Thus, moderate postoperative anemia has limited impact on early postdischarge functional recovery after fast-track THA.
在快速康复髋关节置换术（THA）中，术后贫血很常见，此类手术患者早期即可活动并出院，但此前尚未充分评估贫血是否会影响出院后的功能恢复。本研究旨在评估THA出院后前2周内术后贫血是否会影响活动能力恢复和生活质量（Qol）。
这是一项针对122例65岁以上THA患者的前瞻性观察性研究。术前和术后通过6分钟步行试验（6MWT；主要结局指标）、计时起立行走试验和FACT-贫血子量表评估活动能力和Qol。出院后第1至6天通过活动监测评估在家中的24小时活动能力。使用双变量和多变量线性回归比较出院时的血红蛋白（Hb）（HbD）以及与术前相比Hb的下降幅度（ΔHb）和出院后前2周的活动能力及Qol。
HbD和ΔHb的均值（±标准差）分别为（±1.4）和（±1.2）g/dL，与出院后2周的6MWT弱相关（分别为r = 0.23和r = -0.20；p < 0.05），但HbD水平与其他活动能力或Qol指标无关。在对术前患者相关因素进行调整后，HbD解释了6MWT恢复变化的6%（95%置信区间，0%-9%；p < 0.05）。
尽管术后Hb与6MWT恢复之间存在微弱但显著的相关性，但所有其他活动能力和Qol指标均不受术后Hb的影响。因此，快速康复THA术后中度贫血对出院后早期功能恢复的影响有限。
