Meybohm Patrick, Kohlhof Hendrik, Wirtz Dieter Christian, Marzi Ingo, Füllenbach Christoph, Choorapoikayil Suma, Wittmann Maria, Marschall Ursula, Thoma Josef, Schwendner Klaus, Stark Patrick, Raadts Ansgar, Friedrich Jens, Weigt Henry, Friederich Patrick, Huber Josef, Gutjahr Martin, Schmitt Elke, Zacharowski Kai
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt.
Department of Orthopedics and Trauma Surgery, University Hospital Bonn.
Z Orthop Unfall. 2020 Apr;158(2):194-200. doi: 10.1055/a-0974-4115. Epub 2019 Sep 18.
Approximately one in three patients has untreated preoperative anaemia, which in turn is associated with an increased need for transfusion of allogenic red blood cell concentrates (RBC) and complications in the context of a surgical intervention. Here, the prevalence of preoperative and postoperative anaemia as well as their effects on transfusion rate, hospital length of stay and hospital mortality in primary hip and knee arthroplasty has been analysed.
From January 2012 to September 2018, 378,069 adult inpatients from 13 German hospitals were analysed on the basis of an anonymized registry. Of these, n = 10,017 patients had a hip and knee joint primary arthroplasty. The primary endpoint was the incidence of preoperative anaemia, which was analysed by the first available preoperative haemoglobin value according to the WHO definition. Secondary endpoints included in-hospital length of stay, number of patients with red blood cell concentrate transfusion, incidence of hospital-acquired anaemia, number of deceased patients, and postoperative complications.
The preoperative anaemia rate was 14.8% for elective knee joint arthroplasty, 22.9% for elective hip joint arthroplasty and 45.0% for duo-prosthesis implantation. Preoperative anaemia led to a significantly higher transfusion rate (knee: 8.3 vs. 1.8%; hip: 34.5 vs. 8.1%; duo-prosthesis: 42.3 vs. 17.4%), an increased red blood cell concentrate consumption (knee: 256 ± 107 vs. 29 ± 5 RBC/1000 patients; hip: 929 ± 60 vs. 190 ± 16 RBC/1000 patients; duo-prosthesis: 1411 ± 98 vs. 453 ± 42 RBC/1000 patients). Pre-operative anaemia was associated with prolonged hospital stay (12.0 [10.0; 17.0] d vs. 11.0 [9.0; 13.0] d; p < 0.001) and increased mortality (5.5% [4.6 - 6.5%] vs. 0.9% [0.7 - 1.2%]; Fisher p < 0.001) compared to non-anaemic patients. In patients aged 80 years and older, the incidence of preoperative anaemia and thus the transfusion rate was almost twice as high as in patients under 80 years of age.
Preoperative anaemia is common in knee and hip primary arthroplasty and was associated with a relevant increase in red blood cell concentrate consumption. In the context of patient blood management, a relevant potential arises, especially in elective orthopaedic surgery, to better prepare elective patients, to avoid unnecessary transfusions and thus to conserve the valuable resource blood.
约三分之一的患者术前存在未治疗的贫血，这反过来又与异体红细胞浓缩物（RBC）输血需求增加以及手术干预相关并发症有关。在此，分析了初次髋关节和膝关节置换术中术前和术后贫血的患病率及其对输血率、住院时间和医院死亡率的影响。
2012年1月至2018年9月，基于匿名登记系统对来自13家德国医院的378,069名成年住院患者进行了分析。其中，n = 10,017例患者接受了髋关节和膝关节初次置换术。主要终点是术前贫血的发生率，根据世界卫生组织的定义，通过首次获得的术前血红蛋白值进行分析。次要终点包括住院时间、接受红细胞浓缩物输血的患者数量、医院获得性贫血的发生率、死亡患者数量和术后并发症。
择期膝关节置换术的术前贫血率为14.8%，择期髋关节置换术为22.9%，双假体植入术为45.0%。术前贫血导致输血率显著升高（膝关节：8.3%对1.8%；髋关节：34.5%对8.1%；双假体：42.3%对17.4%），红细胞浓缩物消耗量增加（膝关节：256±107对29±5 RBC/1000例患者；髋关节：929±60对190±16 RBC/1000例患者；双假体：1411±98对453±42 RBC/1000例患者）。与非贫血患者相比，术前贫血与住院时间延长（12.0 [10.0；17.0]天对11.0 [9.0；13.0]天；p < 0.001）和死亡率增加（5.5% [4.6 - 6.5%]对0.9% [0.7 - 1.2%]；Fisher p < 0.001）相关。在80岁及以上的患者中，术前贫血的发生率以及输血率几乎是非80岁以下患者的两倍。
术前贫血在膝关节和髋关节初次置换术中很常见，并且与红细胞浓缩物消耗量的显著增加有关。在患者血液管理方面，特别是在择期骨科手术中，存在一个相关的潜在机会，即更好地为择期患者做准备，避免不必要的输血，从而节约宝贵的血液资源。
