Department of Orthopaedic and Trauma surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium.
Experimental and Clinical Research Institute (IREC), Neuro-Musculo-Skeletal Pole (NMSK), Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
Orthop Traumatol Surg Res. 2023 Nov;109(7):103597. doi: 10.1016/j.otsr.2023.103597. Epub 2023 Mar 15.
Routine laboratory studies are often performed following total hip arthroplasty (THA). However, lately, their necessity has been challenged and risk factors for postoperative transfusion are still debated. Recently, a risk scoring system to single out patients that should have a postoperative blood test has been published by Wu et al. The purposes of this retrospective study were: (1) to validate this recently published risk scoring system to identify patients who should have a postoperative laboratory test; (2) to single out risk factors of postoperative transfusion; (3) to determine if another score can more accurately predict the need for postoperative transfusion.
Wu et al.'s risk scoring system can accurately identify patients who should have a postoperative blood test.
In all, 1693 patients who underwent primary THAs between June 2015 and October 2020 were screened for potential eligibility to include 1000 patient for analysis. Preoperative and postoperative blood tests were done for every patient. Clinical information and laboratory results were retrospectively collected and analyzed. A descriptive analysis followed by univariate and multivariate analysis were sequentially performed. A multiple logistic regression model was employed to determine a formula predicting the transfusion risk called THABUS for Total Hip Arthroplasty Blood test Usefulness Score. The risk scoring system for complete blood count published by Wu et al. in may 2020 was performed for every patient and compared to the THABUS predictive model.
The transfusion rate was 2.3% (23/1000). The risk-scoring system published by Wu and al. showed that a laboratory test was necessary for 60.6% (606/1000) however 13% (3/23) of the patients who needed a blood transfusion were missed by the risk-scoring system, giving it a sensitivity of 86.95% and a specificity of 40%. Increasing age, arterial hypertension, female gender, low preoperative hemoglobin, ASA score≥2 and diagnosis of osteonecrosis of the femoral head were significantly associated with postoperative transfusion. The THABUS formula can predict the risk for transfusion with a sensibility of 96.65% and a specificity of 75.54%. In our cohort of 1000 patients, following the THABUS formula would have led to 261 postoperative blood test and cost savings of 32,132$. Only one patient (4.3%) was missed by our new score. The THABUS formula is significantly better than Wu et al.'s complete blood count score in identifying both patient that will need a transfusion (p<0.01) and those who shouldn't have a postoperative blood test (p<0.001). Medical intervention because of creatinine or electrolytes abnormality was needed in 0.3% (3/1000) of patients.
In this study Wu et al.'s recently published complete blood count risk-scoring system was not validated. However, in the studied population the THABUS formula can accurately target patients who might need a transfusion. The use of the THABUS formula could reduce hospitalization costs without compromising the patients' safety.
III, case-control study.
全髋关节置换术后（THA）常进行常规实验室检查。然而，最近，人们对其必要性提出了质疑，术后输血的风险因素仍存在争议。最近，Wu 等人发表了一种风险评分系统，用于确定需要术后血液检查的患者。本回顾性研究的目的是：（1）验证 Wu 等人最近发表的风险评分系统，以确定需要进行术后实验室检查的患者；（2）确定术后输血的风险因素；（3）确定是否有其他评分可以更准确地预测术后输血的需求。
Wu 等人的风险评分系统可以准确识别需要术后血液检查的患者。
共筛选了 1693 例 2015 年 6 月至 2020 年 10 月期间接受初次 THA 的患者，纳入 1000 例患者进行分析。对每位患者进行术前和术后血液检查。回顾性收集并分析临床信息和实验室结果。首先进行描述性分析，然后进行单因素和多因素分析。采用多元逻辑回归模型确定一种预测输血风险的公式，称为 THABUS（用于全髋关节置换术血液检查有用性评分的公式）。对 Wu 等人 2020 年 5 月发表的用于全血细胞计数的风险评分系统对每位患者进行评估，并与 THABUS 预测模型进行比较。
输血率为 2.3%（23/1000）。Wu 等人发表的风险评分系统显示，60.6%（1000/1693）的患者需要进行实验室检查，但 Wu 等人发表的风险评分系统漏诊了 13%（3/23）需要输血的患者，其敏感性为 86.95%，特异性为 40%。年龄增长、动脉高血压、女性、术前血红蛋白低、ASA 评分≥2 和股骨头坏死诊断与术后输血显著相关。THABUS 公式可以预测输血风险，敏感性为 96.65%，特异性为 75.54%。在我们的 1000 例患者队列中，根据 THABUS 公式进行检查，将导致 261 例术后血液检查，节省 32,132 美元。只有 1 例患者（4.3%）被我们的新评分遗漏。THABUS 公式在识别需要输血的患者（p<0.01）和不需要术后血液检查的患者（p<0.001）方面均明显优于 Wu 等人的全血细胞计数评分。因肌酐或电解质异常而需要医学干预的患者比例为 0.3%（3/1000）。
在本研究中，Wu 等人最近发表的全血细胞计数风险评分系统未得到验证。然而，在研究人群中，THABUS 公式可以准确地确定可能需要输血的患者。使用 THABUS 公式可以降低住院费用，同时不会影响患者的安全性。
III，病例对照研究。
