Schmerler Jessica, Olson Jarod T, Prasad Niyathi, LaPorte Dawn
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Hand (N Y). 2025 Mar;20(2):269-276. doi: 10.1177/15589447231205615. Epub 2023 Oct 24.
Preoperative anemia has been shown to be associated with complications after numerous orthopedic procedures. No studies to our knowledge have examined its impact on outcomes after open reduction internal fixation (ORIF) of distal radius fracture (DRF). We hypothesized that patients with preoperative anemia would have increased likelihood of adverse outcomes, and likelihood would increase with severity of anemia.
A total of 14 136 patients underwent ORIF for DRF over 2012-2021, identified in the National Surgical Quality Improvement Program database. Patients were classified by World Health Organization criteria as nonanemic (hematocrit >36% for women, >39% for men), mildly anemic (hematocrit 33%-36% for women, 33%-39% for men), or moderately to severely anemic (hematocrit <33% for women or men). Multivariable regressions adjusted for age, sex, race, and comorbidities statistically different between anemic and nonanemic patients were used to examine the effect of anemia on postoperative outcomes.
Mildly anemic patients had significantly longer length of stay and were significantly more likely to experience readmission and sepsis ( < .05 all). Moderately to severely anemic patients had significantly longer length of stay and were significantly more likely to experience readmission, postoperative transfusion, septic shock, and any adverse event ( < .05 all).
Preoperative anemia is associated with increased likelihood of adverse outcomes after ORIF for DRF, and likelihood increases with severity of anemia. Surgeons should monitor patients for preoperative anemia and endeavor to identify the source of and, if safe and possible, correct the anemia preoperatively or manage and educate patients postoperatively.
术前贫血已被证明与多种骨科手术后的并发症相关。据我们所知，尚无研究探讨其对桡骨远端骨折切开复位内固定术（ORIF）后结局的影响。我们假设术前贫血患者出现不良结局的可能性增加，且这种可能性会随着贫血严重程度的增加而升高。
在国家外科质量改进计划数据库中识别出2012年至2021年期间共14136例行桡骨远端骨折切开复位内固定术的患者。根据世界卫生组织标准，将患者分为非贫血（女性血细胞比容>36%，男性>39%）、轻度贫血（女性血细胞比容33%-36%，男性33%-39%）或中度至重度贫血（女性或男性血细胞比容<33%）。采用多变量回归分析，对贫血患者和非贫血患者之间在年龄、性别、种族和合并症方面存在统计学差异的因素进行校正，以研究贫血对术后结局的影响。
轻度贫血患者的住院时间显著延长，再次入院和发生脓毒症的可能性显著更高（均P<0.05）。中度至重度贫血患者的住院时间显著延长，再次入院、术后输血、感染性休克及任何不良事件的发生可能性显著更高（均P<0.05）。
术前贫血与桡骨远端骨折切开复位内固定术后不良结局的可能性增加相关，且可能性随贫血严重程度的增加而升高。外科医生应监测患者是否存在术前贫血，并努力找出贫血的原因，在安全可行的情况下，术前纠正贫血，或在术后对患者进行管理和教育。
