Telang Sagar S, Palmer Ryan C, Yoshida Brandon, Ball Jacob R, Lieberman Jay R, Heckmann Nathanael D
Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
J Arthroplasty. 2025 Jul;40(7S1):S169-S175.e5. doi: 10.1016/j.arth.2025.02.058. Epub 2025 Feb 26.
Preoperative anemia, defined by the World Health Organization as hemoglobin levels below 12.0 g/dL in women and below 13.0 g/dL in men, has been associated with postoperative complications following total knee arthroplasty (TKA). This study sought to utilize preoperative hemoglobin levels to assess the risk of early postoperative adverse events following elective TKA.
An inpatient and outpatient encounters database was utilized to identify all primary TKA patients between 2016 and 2021 who had a preoperative hemoglobin value within 28 days of surgery. Restricted cubic splines were generated utilizing multivariable logistic regression models to assess the relationship between hemoglobin, as a continuous variable, and the 90-day risk of periprosthetic joint infection (PJI), aggregate medical complications, and aggregate surgical complications. Hemoglobin changepoints were identified beyond which the risk of PJI significantly increased. In total, 61,857 TKA patients (women: 37,800 [61.1%]; men: 24,057 [38.9%]) were identified with preoperative hemoglobin values, of which 367 (0.60%) developed a PJI.
The risk of PJI, aggregate medical complications, and aggregate surgical complications was found to significantly increase for patients who had a hemoglobin < 13.0 g/dL (men < 13.0 g/dL; women < 12.7 g/dL). Patients who had a hemoglobin of 10 g/dL had a 1.86-fold (95% confidence interval [CI]: 1.44 to 2.41) increased risk of PJI, a 2.72 (CI: 2.56 to 2.90) times increased risk of medical complications, and a 2.16-fold (CI: 1.82 to 2.57) increased risk of aggregate surgical complications. No increased risk of adverse events was found for hemoglobin values > 13.0 g/dL.
Preoperative anemia is associated with early postoperative adverse outcomes, including PJI, following elective TKA. Further study is necessary to determine if correction of low preoperative hemoglobin decreases is associated with decreased complication rates or if low hemoglobin values are a surrogate for chronic diseases that increase the postoperative risk of complications.
世界卫生组织将术前贫血定义为女性血红蛋白水平低于12.0 g/dL，男性低于13.0 g/dL，全膝关节置换术（TKA）后，术前贫血与术后并发症相关。本研究旨在利用术前血红蛋白水平评估择期TKA术后早期不良事件的风险。
利用住院和门诊病历数据库，确定2016年至2021年间所有在手术前28天内有术前血红蛋白值的初次TKA患者。利用多变量逻辑回归模型生成受限立方样条，以评估作为连续变量的血红蛋白与假体周围关节感染（PJI）、总体医疗并发症和总体手术并发症的90天风险之间的关系。确定血红蛋白变化点，超过该点PJI风险显著增加。总共确定了61857例有术前血红蛋白值的TKA患者（女性：37800例[61.1%]；男性：24057例[38.9%]），其中367例（0.60%）发生了PJI。
发现血红蛋白<13.0 g/dL的患者（男性<13.0 g/dL；女性<12.7 g/dL）发生PJI、总体医疗并发症和总体手术并发症的风险显著增加。血红蛋白为10 g/dL的患者发生PJI的风险增加1.86倍（95%置信区间[CI]：1.44至2.41），发生医疗并发症的风险增加2.72倍（CI：2.56至2.90），发生总体手术并发症的风险增加2.16倍（CI：1.82至2.57）。未发现血红蛋白值>13.0 g/dL的患者不良事件风险增加。
术前贫血与择期TKA术后早期不良结局相关，包括PJI。有必要进一步研究以确定纠正术前低血红蛋白是否与并发症发生率降低相关，或者低血红蛋白值是否是增加术后并发症风险的慢性疾病的替代指标。
