Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Alix School of Medicine, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2024 Jun;33(6):1243-1253. doi: 10.1016/j.jse.2023.10.005. Epub 2023 Nov 20.
Anemia is a major cause of morbidity worldwide and compounds numerous medical conditions. Studies have found associations between anemia and both medical and surgical complications after shoulder arthroplasty (SA); however, most of these studies have used commercially available national databases with limited information on outcomes and typically short-term follow-up. Our study sought to evaluate the midterm outcomes of primary SA at a single institution when stratified by the degree of preoperative anemia.
Between 2000 and 2020, 5231 primary SA (477 hemiarthroplasties, 2091 anatomic total SA, and 2335 reverse SA) with preoperative hematocrit values available and a minimum follow-up of 2 years were collected from a single-institution joint registry database. The severity of anemia was subclassified as no anemia (hematocrit >39% for males, >36% for females; n = 4194 [80.2%]), mild anemia (hematocrit 33%-39% for males, 33%-36% for females; n = 742 [14.2%]), and moderate-to-severe anemia (hematocrit <33% for both males and females; n = 295 [5.6%]). The mean follow-up time for the entire cohort was 5.9 years (range, 2-22 years). Medical and surgical complications, reoperations, revisions, and implant survivorship were assessed.
SA with moderate-to-severe anemia had the highest rate of nonfatal and nontransfusion medical complications (5.1%) relative to the nonanemic (1.2%; P < .001) and mild anemic groups (1.5%; P < .001). Similarly, SA with moderate-to-severe anemia had the highest rate of surgical complications (19.3%) compared with mild anemia (14.3%; P = .044) and no anemia (11.6%; P < .001). Postoperative transfusion was most frequent in the moderate-to-severe anemia cohort (40.3%) compared with the mild anemia (14.2%; P < .001) and nonanemic groups (2.5%; P < .001). Furthermore, SA who received postoperative transfusions had a higher risk of nonfatal medical complications (8.2% vs. 1.0%; P < .001), 90-day mortality (1.5% vs. 0.03%; P = .001), and surgical complications (19.5% vs. 12.0%; P < .001) when compared with those without transfusion.
Moderate-to-severe anemia (hematocrit <33% for both males and females) was identified in approximately 5.6% of patients who underwent SA at a single institution and was associated with increased medical and surgical complications. Patients who received postoperative transfusions presented elevated rates of medical complications, 90-day mortality, and surgical complications. Health care teams should be aware of these risks in order to provide more individualized medical optimization and postoperative monitoring.
贫血是全球范围内发病率的主要原因，且会加重许多医疗状况。研究发现，贫血与肩关节炎置换术后（SA）的医疗和手术并发症均有关联；然而，这些研究大多数使用了商业上可用的、信息有限的国家数据库，且通常随访时间较短。本研究旨在评估单中心接受初次 SA 治疗的患者的中期结果，并按术前贫血程度进行分层。
我们从单中心关节登记数据库中收集了 2000 年至 2020 年间 5231 例初次 SA（477 例半髋关节置换术、2091 例解剖型全髋关节置换术和 2335 例反式髋关节置换术）的数据，这些患者术前均有血细胞比容值，且随访时间至少 2 年。根据贫血严重程度将其分为无贫血（男性血细胞比容>39%，女性血细胞比容>36%；n=4194[80.2%]）、轻度贫血（男性血细胞比容 33%-39%，女性血细胞比容 33%-36%；n=742[14.2%]）和中重度贫血（男性和女性的血细胞比容均<33%；n=295[5.6%]）。整个队列的平均随访时间为 5.9 年（范围：2-22 年）。评估了医疗和手术并发症、再次手术、翻修和植入物存活率。
与非贫血组（1.2%；P<.001）和轻度贫血组（1.5%；P<.001）相比，中重度贫血组（5.1%）的非致命性和非输血相关医疗并发症发生率最高。同样，与轻度贫血组（14.3%；P=.044）和非贫血组（11.6%；P<.001）相比，中重度贫血组（19.3%）的手术并发症发生率最高。中重度贫血组（40.3%）术后输血最频繁，而轻度贫血组（14.2%）和非贫血组（2.5%）输血相对较少（P<.001）。此外，接受术后输血的 SA 患者发生非致命性医疗并发症（8.2% vs. 1.0%；P<.001）、90 天死亡率（1.5% vs. 0.03%；P=.001）和手术并发症（19.5% vs. 12.0%；P<.001）的风险更高。
在单中心接受 SA 的患者中，约有 5.6%存在中重度贫血（男性和女性的血细胞比容均<33%），并与医疗和手术并发症增加相关。接受术后输血的患者发生医疗并发症、90 天死亡率和手术并发症的风险更高。医疗保健团队应了解这些风险，以便提供更个体化的医疗优化和术后监测。
