Yeh Jared Ze Yang, Chen Jerry Yongqiang, Bin Abd Razak Hamid Rahmatullah, Loh Bryan Huai Gu, Hao Ying, Yew Andy Khye Soon, Chia Shi-Lu, Lo Ngai Nung, Yeo Seng Jin
Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, 169608, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2016 Oct;24(10):3293-3298. doi: 10.1007/s00167-016-4183-1. Epub 2016 May 28.
The purpose of this study is to determine preoperative haemoglobin cut-off values that could accurately predict post-operative transfusion outcome in patients undergoing primary unilateral total knee arthroplasty (TKA). This will allow surgeons to provide selective preoperative type and screen to only patients at high risk of transfusion.
A total of 1457 patients diagnosed with osteoarthritis and underwent primary unilateral TKA between January 2012 and December 2014 were retrospectively reviewed. Logistic regression analyses were applied to identify factors that could predict transfusion outcome.
A total of 37 patients (2.5 %) were transfused postoperatively. Univariate analysis revealed preoperative haemoglobin (p < 0.001), age (p < 0.001), preoperative haematocrit (p < 0.001), and preoperative creatinine (p < 0.001) to be significant predictors. In the multivariate analysis with patients dichotomised at 70 years of age, preoperative haemoglobin remained significant with adjusted odds ratio of 0.33. Receiver operating characteristic curve identified the preoperative haemoglobin cut-off values to be 12.4 g/dL (AUC = 0.86, sensitivity = 87.5 %, specificity = 77.2 %) and 12.1 g/dL (AUC = 0.85, sensitivity = 69.2 %, specificity = 87.1 %) for age above and below 70, respectively.
The authors recommend preoperative haemoglobin cut-off values of 12.4 g/dL for age above 70 and 12.1 g/dL for age below 70 to be used to predict post-operative transfusion requirements in TKA. To maximise the utilisation of blood resources, the authors recommend that only patients with haemoglobin level below the cut-off should receive routine preoperative type and screen before TKA.
IV.
本研究旨在确定术前血红蛋白临界值，以准确预测初次单侧全膝关节置换术（TKA）患者的术后输血结局。这将使外科医生能够仅对输血高风险患者进行选择性术前血型鉴定和筛查。
回顾性分析2012年1月至2014年12月期间共1457例诊断为骨关节炎并接受初次单侧TKA的患者。应用逻辑回归分析确定可预测输血结局的因素。
共有37例患者（2.5%）术后接受了输血。单因素分析显示术前血红蛋白（p<0.001）、年龄（p<0.001）、术前血细胞比容（p<0.001）和术前肌酐（p<0.001）是显著预测因素。在按70岁进行二分法的患者多因素分析中，术前血红蛋白仍然显著，调整后的优势比为0.33。受试者工作特征曲线确定，70岁及以上患者术前血红蛋白临界值为12.4 g/dL（AUC=0.86，敏感性=87.5%，特异性=77.2%），70岁以下患者为 12.1 g/dL（AUC=0.85，敏感性=69.2%，特异性=87.1%）。
作者建议，70岁及以上患者术前血红蛋白临界值为12.4 g/dL，70岁以下患者为12.1 g/dL，用于预测TKA术后输血需求。为了最大限度地利用血液资源，作者建议只有血红蛋白水平低于临界值的患者在TKA术前应接受常规血型鉴定和筛查。
IV级。
