Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
Department of Orthopedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, People's Republic of China.
J Orthop Surg Res. 2021 Oct 30;16(1):643. doi: 10.1186/s13018-021-02642-9.
Enhanced recovery after surgery (ERAS) program advocates implementation of perioperative goal-directed fluid therapy and reduced application of colloidal fluids. It should be used reasonably selectively in high-risk patients despite the clear efficacy of human albumin (HA). Therefore, it is vital to identify the risk factors for the use of HA. This study aims to determine the incidence and risk factors of HA administration in patients undergoing total hip or knee arthroplasty (THA, TKA).
We identified patients undergoing THA or TKA in multiple institutions from 2014 to 2016 and collected patient demographics and perioperative variables. The criterion of HA administration was defined as a postoperative albumin level < 32 g/L or 32 to 35 g/L for at-risk patients. We compared 14 variables between patients who received HA administration and those who did not after stratification by the preoperative albumin (pre-ALB) level. Multivariable regressions identified the independent risk factors associated with HA administration.
In total, 958 (20.3%) of 4713 patients undergoing THA and 410 (9.7%) of 4248 patients undergoing TKA received HA administration. In addition to pre-ALB < 35 g/L, preoperative anemia (odds ratio [OR] 2.12, P = 0.001; OR 1.39, P < 0.001) and drain use (OR 3.33, P = 0.001; OR 4.25, P < 0.001) were also independent risk factors for HA administration after THA regardless pre-ALB < 35 g/L or not, and patients undergoing TKA diagnosed of rheumatoid arthritis or ankylosing spondylitis tended to receive HA administration regardless pre-ALB < 35 g/L or not (OR 3.67, P = 0.002; OR 2.06, P < 0.001).
The incidence of HA administration was high in patients undergoing THA or TKA, and several variables were risk factors for HA administration. This finding may aid surgeons in preoperatively identifying patients requiring HA administration and optimizing perioperative managements.
术后加速康复（ERAS）方案提倡实施围手术期目标导向的液体治疗和减少胶体液的应用。尽管人血白蛋白（HA）的疗效明确，但在高危患者中应合理选择使用。因此，确定使用 HA 的危险因素至关重要。本研究旨在确定行全髋关节或膝关节置换术（THA、TKA）患者中 HA 给药的发生率和危险因素。
我们从 2014 年至 2016 年在多个机构中确定了行 THA 或 TKA 的患者，并收集了患者的人口统计学和围手术期变量。HA 给药的标准定义为术后白蛋白水平<32 g/L 或高危患者白蛋白水平为 32 至 35 g/L。我们根据术前白蛋白（pre-ALB）水平将患者分为接受 HA 给药和未接受 HA 给药两组，比较了两组间的 14 个变量。多变量回归确定了与 HA 给药相关的独立危险因素。
共纳入 4713 例行 THA 的患者中有 958 例（20.3%）和 4248 例行 TKA 的患者中有 410 例（9.7%）接受了 HA 给药。除 pre-ALB<35 g/L 外，术前贫血（比值比[OR]2.12，P=0.001；OR1.39，P<0.001）和引流管使用（OR3.33，P=0.001；OR4.25，P<0.001）也是 THA 后 HA 给药的独立危险因素，无论 pre-ALB<35 g/L 与否，行 TKA 的类风湿关节炎或强直性脊柱炎患者倾向于使用 HA（OR3.67，P=0.002；OR2.06，P<0.001）。
THA 或 TKA 患者 HA 给药的发生率较高，多个变量是 HA 给药的危险因素。这一发现可能有助于外科医生在术前识别需要 HA 给药的患者，并优化围手术期管理。
