Institute for Anesthesia and Intensive Care Medicine, Spital Thurgau, 8501, Frauenfeld, Switzerland.
Department of Orthopedic Surgery and Traumatology, Spital Thurgau, Frauenfeld, Switzerland.
Arch Orthop Trauma Surg. 2022 Aug;142(8):1817-1822. doi: 10.1007/s00402-021-03763-w. Epub 2021 Feb 19.
Accurate identification of patients at risk of blood transfusion can reduce complications and improve institutional resource allocation. Probabilistic models are used to detect risk factors and formulate patient blood management strategies. Whether these predictors vary among institutions is unclear. We aimed to identify risk factors among our patients who underwent total hip (THA) or knee (TKA) arthroplasty, and combine these predictors to improve our model.
We retrospectively assessed risk factors among 531 adults who underwent elective THA or TKA from January 2016 to November 2018. Using relevant surgical and patient characteristics gathered from electronic medical records, we conducted univariable and multivariable analyses. For our logistic regression model, we measured the impact of independent variables (age, gender, operation type (THA or TKA) and preoperative hemoglobin concentration) on the need for a transfusion.
Of the 531 patients, 321 had THA (uncemented) and 210 had TKA. For the selected period, our transfusion rate of 8.1% (10.6% THA and 4.3% TKA) was low. Univariable analyses showed that lower BMI (p < 0.001) was associated with receiving a transfusion. Important factors identified through logistic regression analyses were age (estimated effect of an interquartile range increase in age: OR 3.89 [CI 95% 1.96-7.69]), TKA (OR - 0.77 [CI 95% - 1.57-0.02]), and preoperative hemoglobin levels (estimated effect of interquartile range increase in hemoglobin: OR 0.47 [CI 95% 0.31-0.71]). Contrary to findings from previous reports, gender was not associated with transfusion.
Previously published predictors such as advanced age, low preoperative hemoglobin, and procedure type (THA) were also identified in our analysis. However, gender was not a predictor, and BMI showed the potential to influence risk. We conclude that, when feasible, the determination of site-specific transfusion rates and combined risk factors can assist practitioners to customize care according to the needs of their patient population.
Level 3, retrospective cohort study.
准确识别需要输血的患者可以减少并发症并改善机构资源配置。概率模型用于检测危险因素并制定患者血液管理策略。这些预测因子在不同机构之间是否存在差异尚不清楚。我们旨在确定在接受全髋关节置换术（THA）或全膝关节置换术（TKA）的患者中存在的危险因素，并将这些预测因子结合起来以改进我们的模型。
我们回顾性评估了 2016 年 1 月至 2018 年 11 月期间接受择期 THA 或 TKA 的 531 例成人的危险因素。我们使用从电子病历中收集的相关手术和患者特征，进行单变量和多变量分析。对于我们的逻辑回归模型，我们测量了独立变量（年龄、性别、手术类型（THA 或 TKA）和术前血红蛋白浓度）对输血需求的影响。
在 531 例患者中，321 例行非骨水泥 THA，210 例行 TKA。在所选择的时间段内，我们的输血率为 8.1%（THA 为 10.6%，TKA 为 4.3%）较低。单变量分析表明，较低的 BMI（p<0.001）与输血有关。通过逻辑回归分析确定的重要因素包括年龄（年龄每增加一个四分位间距的估计效应：OR 3.89 [95%CI 1.96-7.69]）、TKA（OR-0.77 [95%CI-1.57-0.02]）和术前血红蛋白水平（血红蛋白每增加一个四分位间距的估计效应：OR 0.47 [95%CI 0.31-0.71]）。与之前的报告结果相反，性别与输血无关。
我们的分析还确定了先前发表的预测因子，如高龄、低术前血红蛋白和手术类型（THA）。然而，性别不是预测因子，BMI 可能会影响风险。我们得出的结论是，在可行的情况下，确定特定部位的输血率和综合危险因素可以帮助医生根据患者人群的需求定制护理。
3 级，回顾性队列研究。
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