Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Transfus Med. 2022 Aug;32(4):306-317. doi: 10.1111/tme.12873. Epub 2022 May 11.
Assess the prognostic value of pre-operative haemoglobin concentration (Hb) for identifying patients who develop severe post-operative anaemia or require blood transfusion following primary total hip or knee, or unicompartmental knee arthroplasty (THA, TKA, UKA).
Pre-operative group and save (G&S), and post-operative Hb measurement may be unnecessary for many patients undergoing hip and knee arthroplasty provided individuals at greatest risk of severe post-operative anaemia can be identified.
Patients undergoing THA, TKA, or UKA between 2011 and 2018 were included. Outcomes were post-operative Hb below 70 and 80 g/L, and peri-operative blood transfusion. Logistic regression assessed the association between pre-operative Hb and each outcome. Decision curve analysis compared strategies for selecting patients for G&S and post-operative Hb measurement.
10 015 THA, TKA and UKA procedures were performed in 8582 patients. The incidence of blood transfusion (4.5%) decreased during the study. Using procedure specific Hb thresholds to select patients for pre-operative G&S and post-operative Hb testing had a greater net benefit than selecting all patients, no patients, or patients with pre-operative anaemia.
Pre-operative G&S and post-operative Hb measurement may not be indicated for UKA or TKA when adopting restrictive transfusion thresholds, provided clinicians accept a 0.1% risk of patients developing severe undiagnosed post-operative anaemia (Hb < 70 g/L). The decision to perform these blood tests for THA patients should be based on local institutional data and selection of acceptable risk thresholds.
评估术前血红蛋白浓度（Hb）对识别发生严重术后贫血或需要输血的患者的预后价值，这些患者接受初次全髋关节或全膝关节置换术（THA、TKA）或单髁膝关节置换术（UKA）。
对于接受髋关节和膝关节置换术的大多数患者，术前组和保存（G&S）以及术后 Hb 测量可能是不必要的，前提是可以识别出发生严重术后贫血风险最大的个体。
纳入 2011 年至 2018 年间接受 THA、TKA 或 UKA 的患者。结局为术后 Hb<70 和 80g/L，以及围手术期输血。逻辑回归评估术前 Hb 与每种结局的关联。决策曲线分析比较了选择患者进行 G&S 和术后 Hb 测量的策略。
8582 例患者中有 10015 例接受了 THA、TKA 和 UKA 手术。在研究期间，输血的发生率（4.5%）下降。使用特定于手术的 Hb 阈值选择患者进行术前 G&S 和术后 Hb 检测比选择所有患者、无患者或术前贫血患者具有更大的净收益。
当采用限制性输血阈值时，对于 UKA 或 TKA，可能不需要进行术前 G&S 和术后 Hb 检测，前提是临床医生接受 0.1%的患者发生严重未诊断的术后贫血（Hb<70g/L）的风险。是否对 THA 患者进行这些血液检查的决定应基于当地机构数据和可接受风险阈值的选择。
