Bashaireh Khaldoon, Aljararhih Osama, Alawneh Khaldoon
Jordan University of Science and Technology (JUST), Department of Special Surgery, College of Medicine, Irbid, Jordan. P.O.Box 3030, Irbid, 22110, Jordan.
Jordan University of Science and Technology (JUST), Department of Medicine, College of Medicine, Irbid, Jordan. P.O.Box 3030, Irbid, 22110, Jordan.
Ann Med Surg (Lond). 2020 May 28;55:180-184. doi: 10.1016/j.amsu.2020.05.028. eCollection 2020 Jul.
Morbid obesity is a challenge in cases that require total knee arthroplasty, and several studies considered it a contraindication for the procedure due to associated risk of complications, including plummeting hemoglobin levels and subsequent need for a blood transfusion. This study investigated risk factors for blood transfusion in this patient group and considered their relationship to obesity.
Patients' data were extracted from medical records, including estimated blood loss and perioperative hemoglobin levels. Patients were weighed and measured, and their body mass index (BMI) was calculated and stratified according to international criteria.
A total of 188 patients were included in this study; among them, 136 patients had obesity (72%), with a mean BMI of 33.54. The mean volume of blood lost was 1055.4 ml, with the mean postoperative hemoglobin decrease of 1.42 g/dl and 2.88 g/dl at 6 and 24 h after surgery, respectively. The pre-operative Hb level was the only significant risk factor for blood transfusion. BMI did not affect the risk of blood transfusion or amount of blood lost.
Obesity (BMI > 30 kg/m) did not increase the risk of needing a blood transfusion after total knee arthroplasty. A judicious transfusion strategy involving the pre-operative Hb optimization should be adopted in TKA to decrease transfusion rate, benefit patient outcomes, and increase healthcare system efficiency. This study shows that high BMI is not a risk factor for postoperative blood transfusion.
病态肥胖对于需要进行全膝关节置换术的病例而言是一项挑战，并且多项研究认为由于存在包括血红蛋白水平骤降及随后需要输血等并发症相关风险，病态肥胖是该手术的一项禁忌症。本研究调查了该患者群体中输血的风险因素，并探讨了它们与肥胖的关系。
从病历中提取患者数据，包括估计失血量和围手术期血红蛋白水平。对患者进行称重和测量，并根据国际标准计算其体重指数（BMI）并进行分层。
本研究共纳入188例患者；其中，136例患者存在肥胖（72%），平均BMI为33.54。平均失血量为1055.4毫升，术后6小时和24小时血红蛋白平均分别下降1.42克/分升和2.88克/分升。术前血红蛋白水平是输血的唯一显著风险因素。BMI不影响输血风险或失血量。
肥胖（BMI>30kg/m²）并未增加全膝关节置换术后输血的风险。在全膝关节置换术中应采用一种明智的输血策略，包括术前优化血红蛋白水平，以降低输血率、改善患者预后并提高医疗系统效率。本研究表明高BMI并非术后输血的风险因素。
