限制输血管理方案下与下肢翻修关节置换术围手术期输血相关的因素。

Factors Associated With Perioperative Transfusion in Lower Extremity Revision Arthroplasty Under a Restrictive Blood Management Protocol.

机构信息

From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.

出版信息

J Am Acad Orthop Surg. 2021 Apr 15;29(8):e404-e409. doi: 10.5435/JAAOS-D-20-00185.

DOI:10.5435/JAAOS-D-20-00185

PMID:32852330

Abstract

INTRODUCTION

Approximately 37% of patients undergoing lower extremity revision total joint arthroplasty (TJA) receive allogeneic blood transfusions (ABTs), which are associated with increased risk of morbidity and death. It is important to identify patient factors associated with needing ABT because the health of higher-risk patients can be optimized preoperatively and their need for ABT can be minimized. Our goal was to identify the patient and surgical factors independently associated with perioperative ABT in revision TJA.

METHODS

We included all 251 lower extremity revision TJA cases performed at our academic tertiary care center from January 1, 2016, to December 31, 2018. We assessed the following factors for associations with perioperative ABT: patient age, sex, race, body mass index, preoperative hemoglobin level, and infection status (ie, infection as indication for revision TJA); use of vasopressors, tranexamic acid (TXA), surgical drains, tourniquets, and intraoperative cell salvage; and procedure type (hip versus knee), procedure complexity (according to the number of components revised), and surgical time. Multivariable regression was used to identify factors independently associated with perioperative ABT.

RESULTS

The following characteristics were independently associated with greater odds of perioperative ABT: preoperative hemoglobin level (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.5 to 2.2), infectious indication for revision (OR, 3.6; 95% CI, 1.3 to 9.7), and procedure complexity. TXA use was a negative predictor of ABT (OR, 0.47; 95% CI, 0.23 to 0.98). Compared with polyethylene liner exchanges, single-component revisions (OR, 14; 95% CI, 3.6 to 56) and dual-component revisions (OR, 7.8; 95% CI, 2.3 to 26) were associated with greater odds of ABT.

DISCUSSION

Patients with preoperative anemia, those undergoing revision TJA because of infection, those who did not receive TXA, and those undergoing more complex TJA procedures may have greater odds of requiring ABT. We recommend preoperative optimization of the health of these patients to reduce the need for ABT.

LEVEL OF EVIDENCE

Level III, prognostic study.

摘要

简介

大约 37%接受下肢翻修全膝关节置换术（TJA）的患者接受异体输血（ABT），这与发病率和死亡率增加有关。确定与 ABT 相关的患者因素很重要，因为高风险患者的健康可以在术前得到优化，并且可以尽量减少他们对 ABT 的需求。我们的目标是确定与翻修 TJA 围手术期 ABT 相关的患者和手术因素。

方法

我们纳入了 2016 年 1 月 1 日至 2018 年 12 月 31 日在我们学术性三级护理中心进行的所有 251 例下肢翻修 TJA 病例。我们评估了以下因素与围手术期 ABT 的关联：患者年龄、性别、种族、体重指数、术前血红蛋白水平和感染状态（即感染作为翻修 TJA 的指征）；血管加压药、氨甲环酸（TXA）、引流管、止血带和术中细胞回收的使用；以及手术类型（髋关节与膝关节）、手术复杂性（根据修订的组件数量）和手术时间。多变量回归用于确定与围手术期 ABT 相关的独立因素。

结果

以下特征与围手术期 ABT 的可能性更大有关：术前血红蛋白水平（优势比[OR]，1.8；95%置信区间[CI]，1.5 至 2.2）、感染性翻修指征（OR，3.6；95%CI，1.3 至 9.7）和手术复杂性。TXA 的使用是 ABT 的负预测因子（OR，0.47；95%CI，0.23 至 0.98）。与聚乙烯衬垫更换相比，单组件翻修（OR，14；95%CI，3.6 至 56）和双组件翻修（OR，7.8；95%CI，2.3 至 26）与 ABT 的可能性更大有关。