Iacobelli David Silva, Syku Marie, Abutalib Zafir, Berliner Zachary P, Joseph Amethia, Cushner Fred, Boettner Friedrich, Rodriguez José A
Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA, USA.
Arthroplast Today. 2022 Mar 14;14:128-132. doi: 10.1016/j.artd.2022.01.033. eCollection 2022 Apr.
Allogenic blood transfusions increase the risk of multiple complications. We evaluated the influence of restricting transfusions in adults with osteoarthritis that underwent total hip or knee arthroplasty (THA/TKA) with severe postoperative anemia.
Patients that underwent THA/TKA for osteoarthritis with postoperative hemoglobin (Hb) ≤ 8 g/dl were retrospectively identified. We evaluated characteristics and adverse postoperative outcomes of patients not transfused and compared them to those of patients who received postoperative transfusion. Adverse outcomes were 90-day readmission, reoperation, infection, and falls, as well as inpatient cardiovascular events and deaths.
One thousand eighty-seven patients meeting inclusion criteria underwent THA and TKA. The 399 patients (36.7%) who did not undergo transfuion were younger (67.4 vs 69.5 years, = .008), healthier (American Society of Anesthesiologist ≤ 2: 64.2% vs 56%, = .006), comprised a lower proportion of cardiovascular disease patients (13.8% vs 24.7%, < .001), a lower proportion of patients with Medicare/Medicare Managed Care (57.2% vs 65.5%, = .05), received tranexamic acid more frequently (66.4% vs 52.9%, < .01), had a shorter procedure time (92.7 vs 103.1, < .01), a lower postoperative drop in Hb (4.0 vs 4.2 g/dl, = .022), a later drop in Hb (2.6 vs 2.2 days, = .003), and a shorter length of stay (3.5 vs 4.8, < .01). TKA patients underwent transfusion more frequently than THA patients (67.5% vs 59%, = .004). There were no postoperative deaths. Adverse events were similar between the 2 groups.
Findings suggest that younger and healthier patients that have lower Hb later during their hospital stay need not undergo transfusion solely based on Hb levels. Routine transfusion triggers can be avoided even in more anemic patients.
异体输血会增加多种并发症的风险。我们评估了限制对患有骨关节炎且接受全髋关节或膝关节置换术（THA/TKA）并伴有严重术后贫血的成年人进行输血的影响。
回顾性确定因骨关节炎接受THA/TKA且术后血红蛋白（Hb）≤8 g/dl的患者。我们评估了未输血患者的特征和术后不良结局，并将其与接受术后输血的患者进行比较。不良结局包括90天再入院、再次手术、感染和跌倒，以及住院期间的心血管事件和死亡。
1087例符合纳入标准的患者接受了THA和TKA手术。399例（36.7%）未输血的患者更年轻（67.4岁对69.5岁，P = 0.008），更健康（美国麻醉医师协会分级≤2级：64.2%对56%，P = 0.006），心血管疾病患者比例更低（13.8%对24.7%，P < 0.001），医疗保险/医疗保险管理式医疗患者比例更低（57.2%对65.5%，P = 0.05），更频繁接受氨甲环酸治疗（66.4%对52.9%，P < 0.01），手术时间更短（92.7分钟对103.1分钟，P < 0.01），术后Hb下降幅度更小（4.0 g/dl对4.2 g/dl，P = 0.022），Hb下降时间更晚（2.6天对2.2天，P = 0.003），住院时间更短（3.5天对4.8天，P < 0.01）。TKA患者比THA患者输血更频繁（67.5%对59%，P = 0.004）。术后无死亡病例。两组之间的不良事件相似。
研究结果表明，住院后期Hb水平较低但更年轻、更健康的患者不必仅基于Hb水平进行输血。即使是贫血更严重的患者也可避免常规输血触发因素。
