Lu Min, Sing David C, Kuo Alfred C, Hansen Erik N
Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, Pennsylvania.
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
J Arthroplasty. 2017 Sep;32(9S):S197-S201. doi: 10.1016/j.arth.2017.02.076. Epub 2017 Mar 21.
Preoperative anemia is a common, important risk factor for adverse events after joint arthroplasty surgery. It affects 21%-35% patients undergoing total joint arthroplasty. To date, few studies have investigated the effect of preoperative anemia, specifically in revision total joint arthroplasty surgery.
The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent revision total joint arthroplasty from 2006 to 2014. We matched 6830 patients undergoing aseptic revision (3415 anemic vs 3415 not anemic) and 2650 patients undergoing septic revision (1325 anemic vs 1325 not anemic). In each cohort, patients were propensity score-matched 1:1 by the presence of preoperative anemia. The inpatient hospitalization data, postoperative complications, as well as demographics and comorbidities were compared between patients with or without anemia who underwent revision total joint arthroplasty.
After adjusting for comorbidities via multivariate regression, anemia was associated with an increased risk of overall complications (aseptic: odds ratio [OR], 1.45; 95% confidence interval [CI], 1.24-1.70; P < .001; septic: OR, 2.16; 95% CI, 1.83-2.56; P < .001), deep infection (aseptic: OR, 1.68; 95% CI, 1.19-2.38; P = .003; septic: OR, 1.44; 95% CI, 1.06-1.94; P = .018), mortality (aseptic: OR, 2.18; 95% CI, 1.09-4.36; P = .028; septic: OR, 3.16; 95% CI, 1.03-9.74; P = .045), and increased hospital length of stay (aseptic: adjusted coefficient, 1.02 days; 95% CI, 0.73-1.31; P < .001; septic: adjusted coefficient, 2.04 days; 95% CI, 1.53-2.55; P < .001).
Preoperative anemia is independently associated with postoperative complications, mortality, and increased length of stay in revision total joint arthroplasty. Further studies are needed to evaluate if preoperative treatment of anemia may modify this risk.
术前贫血是关节置换术后不良事件常见且重要的危险因素。它影响21%-35%接受全关节置换术的患者。迄今为止，很少有研究调查术前贫血的影响，特别是在翻修全关节置换术中。
利用美国外科医师学会国家外科质量改进计划数据库，识别2006年至2014年接受翻修全关节置换术的患者。我们匹配了6830例接受无菌翻修的患者（3415例贫血患者与3415例非贫血患者）和2650例接受感染性翻修的患者（1325例贫血患者与1325例非贫血患者）。在每个队列中，根据术前贫血情况将患者按1:1进行倾向评分匹配。比较接受翻修全关节置换术的贫血患者与非贫血患者的住院数据、术后并发症以及人口统计学和合并症情况。
通过多因素回归调整合并症后，贫血与总体并发症风险增加相关（无菌性：比值比[OR]，1.45；95%置信区间[CI]，1.24-1.70；P<.001；感染性：OR，2.16；95%CI，1.83-2.56；P<.001）、深部感染（无菌性：OR，1.68；95%CI，1.19-2.38；P=.003；感染性：OR，1.44；95%CI，1.06-1.94；P=.018）、死亡率（无菌性：OR，2.18；95%CI，1.09-4.36；P=.028；感染性：OR，3.16；95%CI，1.03-9.74；P=.045）以及住院时间延长（无菌性：调整系数，1.02天；95%CI，0.73-1.31；P<.001；感染性：调整系数，2.04天；95%CI，1.53-2.55；P<.001）。
术前贫血与翻修全关节置换术后的并发症、死亡率及住院时间延长独立相关。需要进一步研究评估术前治疗贫血是否可降低此风险。
