Jakuscheit Axel, Schaefer Nina, Roedig Johannes, Luedemann Martin, von Hertzberg-Boelch Sebastian Philipp, Weissenberger Manuel, Schmidt Karsten, Holzapfel Boris Michael, Rudert Maximilian
Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97070 Wuerzburg, Germany.
Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany.
J Pers Med. 2021 Nov 18;11(11):1223. doi: 10.3390/jpm11111223.
The primary aim of this study was to identify modifiable patient-related predictors of blood transfusions and perioperative complications in total hip and knee arthroplasty. Individual predictor-adjusted risks can be used to define preoperative treatment thresholds.
We performed this retrospective monocentric study in orthopaedic patients who underwent primary total knee or hip arthroplasty. Multivariate logistic regression models were used to assess the predictive value of patient-related characteristics. Predictor-adjusted individual risks of blood transfusions and the occurrence of any perioperative adverse event were calculated for potentially modifiable risk factors.
3754 patients were included in this study. The overall blood transfusion and complication rates were 4.8% and 6.4%, respectively. Haemoglobin concentration (Hb, < 0.001), low body mass index (BMI, < 0.001) and estimated glomerular filtration rate (eGFR, = 0.004) were the strongest potentially modifiable predictors of a blood transfusion. EGFR ( = 0.001) was the strongest potentially modifiable predictor of a complication. Predictor-adjusted risks of blood transfusions and acute postoperative complications were calculated for Hb and eGFR. Hb = 12.5 g/dL, BMI = 17.6 kg/m, and eGFR = 54 min/mL were associated, respectively, with a 10% risk of a blood transfusion, eGFR = 59 mL/min was associated with a 10% risk of a complication.
The individual risks for blood transfusions and acute postoperative complications are strongly increased in patients with a low preoperative Hb, low BMI or low eGFR. We recommend aiming at a preoperative Hb ≥ 13g/dL, an eGFR ≥ 60 mL/min and to avoid a low BMI. Future studies must show if a preoperative increase of eGFR and BMI is feasible and truly beneficial.
本研究的主要目的是确定全髋关节和膝关节置换术中可改变的与患者相关的输血及围手术期并发症预测因素。个体预测因素调整后的风险可用于确定术前治疗阈值。
我们对接受初次全膝关节或髋关节置换术的骨科患者进行了这项回顾性单中心研究。采用多变量逻辑回归模型评估与患者相关特征的预测价值。针对潜在可改变的风险因素，计算预测因素调整后的个体输血风险及任何围手术期不良事件的发生风险。
本研究纳入了3754例患者。总体输血率和并发症发生率分别为4.8%和6.4%。血红蛋白浓度（Hb，<0.001）、低体重指数（BMI，<0.001）和估算肾小球滤过率（eGFR，=0.004）是输血最强的潜在可改变预测因素。eGFR（=0.001）是并发症最强的潜在可改变预测因素。计算了Hb和eGFR的预测因素调整后的输血风险及术后急性并发症风险。Hb = 12.5 g/dL、BMI = 17.6 kg/m²和eGFR = 54 ml/min分别与10%的输血风险相关，eGFR = 59 ml/min与10%的并发症风险相关。
术前Hb低、BMI低或eGFR低的患者输血及术后急性并发症的个体风险显著增加。我们建议术前Hb≥13g/dL、eGFR≥60 ml/min，并避免低BMI。未来的研究必须表明术前提高eGFR和BMI是否可行且真正有益。
