Johns Hopkins Department of Orthopaedic Surgery, Columbia, MD, USA.
Department of Orthopaedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA.
J Shoulder Elbow Surg. 2021 Oct;30(10):2393-2400. doi: 10.1016/j.jse.2021.01.022. Epub 2021 Feb 16.
Anemia has been demonstrated as a modifiable risk factor for postoperative complications following various types of primary and revision total joint arthroplasties. However, at present, we are not aware of any studies assessing postoperative complications following total shoulder arthroplasty (TSA) in patients with varying severity of anemia. The purpose of this study was to determine the influence of preoperative anemia severity on 30-day postoperative complications following primary TSA.
Adult patients undergoing primary TSA from 2012 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients undergoing TSA were substratified into 3 cohorts: nonanemia (hematocrit >36% for women, >39% for men), mild anemia (hematocrit 33%-36% for women, 33%-39% for men), and moderate to severe anemia (hematocrit <33% for both women and men), based on World Health Organization definitions of anemia. In this analysis, 30-day wound, cardiac, pulmonary, renal, and thromboembolic complications, as well as sepsis, mortality, postoperative transfusion, extended length of stay, and reoperation were assessed. Bivariate analyses, including χ and analysis of variance, and multivariable logistical regression were performed.
Of 13,921 total patients undergoing TSA, 11,330 patients (81.4%) did not have anemia, 1934 (13.9%) had mild anemia, and 657 (4.7%) had moderate to severe anemia. Following adjustment, patients with mild anemia were more likely to have a postoperative blood transfusion (odds ratio [OR] 4.7, P < .001), extended length of stay (OR 1.7, P = .002), and reoperation (OR 1.5, P = .028). Patients with moderate to severe anemia were at increased risk of cardiac complications (OR 3.0, P = .012), pulmonary complications (OR 2.2, P = .015), postoperative blood transfusion (OR 23.8, P < .001), extended length of stay (OR 6.6, P < .001), reoperation (OR 2.2, P = .003), and death (OR 3.8, P = .034).
From mild anemia to moderate to severe anemia, there was a stepwise and approximately 2-fold increase in the odds of postoperative complications for patients undergoing primary TSA. Patients with moderate to severe anemia should be medically optimized before they undergo TSA.
贫血已被证明是各种原发性和翻修全关节置换术后术后并发症的可改变危险因素。然而，目前，我们不知道有任何研究评估不同严重程度贫血患者全肩关节置换术（TSA）后的术后并发症。本研究旨在确定术前贫血严重程度对原发性 TSA 后 30 天术后并发症的影响。
在国家手术质量改进计划数据库中确定了 2012 年至 2018 年期间接受原发性 TSA 的成年患者。根据世界卫生组织的贫血定义，将接受 TSA 的患者分为 3 组：非贫血（女性的血细胞比容> 36%，男性> 39%）、轻度贫血（女性的血细胞比容为 33%-36%，男性为 33%-39%）和中重度贫血（女性和男性的血细胞比容均<33%）。在这项分析中，评估了 30 天伤口、心脏、肺部、肾脏和血栓栓塞并发症，以及败血症、死亡率、术后输血、延长住院时间和再次手术。进行了双变量分析，包括卡方和方差分析以及多变量逻辑回归。
在 13921 名接受 TSA 的患者中，11330 名（81.4%）患者无贫血，1934 名（13.9%）患者轻度贫血，657 名（4.7%）患者中重度贫血。调整后，轻度贫血患者更有可能接受术后输血（优势比[OR]4.7，P<.001）、延长住院时间（OR1.7，P=.002）和再次手术（OR1.5，P=.028）。中重度贫血患者发生心脏并发症的风险增加（OR3.0，P=.012）、肺部并发症（OR2.2，P=.015）、术后输血（OR23.8，P<.001）、延长住院时间（OR6.6，P<.001）、再次手术（OR2.2，P=.003）和死亡（OR3.8，P=.034）。
从轻度贫血到中重度贫血，接受原发性 TSA 的患者术后并发症的几率呈阶梯式增加，约为 2 倍。中重度贫血患者应在接受 TSA 前进行医学优化。
