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Zhang FQ, Yang YZ, Li PF, Ma GR, Zhang AR, Zhang H, Guo HZ. Impact of preoperative anemia on patients undergoing total joint replacement of lower extremity: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:249. [PMID: 38637795 PMCID: PMC11027536 DOI: 10.1186/s13018-024-04706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/29/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE Preoperative anemia increases postoperative morbidity, mortality, and the risk of allogeneic transfusion. However, the incidence of preoperative anemia in patients undergoing total hip arthroplasty and total knee arthroplasty (TKA) and its relationship to postoperative outcomes has not been previously reported. METHODS We conducted a comprehensive literature search through PubMed, Cochrane Library, Web of Sincien, and Embase from inception to July 2023 to investigate the prevalence of preoperative anemia in patients undergoing Total Joint Arthroplasty, comorbidities between anemic and non-anemicpatients before surgery, and postoperative outcomes. postoperative outcomes were analyzed. Overall prevalence was calculated using a random-effects model, and heterogeneity between studies was examined by Cochran's Q test and quantified by the I2 statistic. Subgroup analyses and meta-regression analyses were performed to identify sources of heterogeneity. Publication bias was assessed by funnel plots and validated by Egger's test. RESULTS A total of 21 studies with 369,101 samples were included, all of which were retrospective cohort studies. 3 studies were of high quality and 18 studies were of moderate quality. The results showed that the prevalence of preoperative anemia was 22% in patients awaiting arthroplasty; subgroup analyses revealed that the prevalence of preoperative anemia was highest in patients awaiting revision of total knee arthroplasty; the highest prevalence of preoperative anemia was found in the Americas; preoperative anemia was more prevalent in the female than in the male population; and preoperative anemia with a history of preoperative anemia was more common in the female than in the male population. patients with a history of preoperative anemia; patients with joint replacement who had a history of preoperative anemia had an increased risk of infection, postoperative blood transfusion rate, postoperative blood transfusion, Deep vein thrombosis of the lower limbs, days in hospital, readmission within three months, and mortality compared with patients who did not have preoperative anemia. CONCLUSION The prevalence of preoperative anemia in patients awaiting total joint arthroplasty is 22%, and is higher in TKA and female patients undergoing revision, while preoperative anemia is detrimental to the patient's postoperative recovery and will increase the risk of postoperative complications, transfusion rates, days in the hospital, readmission rates, and mortality.
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Affiliation(s)
- Fu-Qiang Zhang
- People's Hospital of Gansu Province, Chengguan District, 204 Donggang West Road, Lanzhou, 730000, China
| | - Yong-Ze Yang
- First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, China.
- People's Hospital of Gansu Province, Chengguan District, 204 Donggang West Road, Lanzhou, 730000, China.
| | - Peng-Fei Li
- First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, China
- People's Hospital of Gansu Province, Chengguan District, 204 Donggang West Road, Lanzhou, 730000, China
| | - Guo-Rong Ma
- First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, China
- People's Hospital of Gansu Province, Chengguan District, 204 Donggang West Road, Lanzhou, 730000, China
| | - An-Ren Zhang
- First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, China
- People's Hospital of Gansu Province, Chengguan District, 204 Donggang West Road, Lanzhou, 730000, China
| | - Hui Zhang
- People's Hospital of Gansu Province, Chengguan District, 204 Donggang West Road, Lanzhou, 730000, China
| | - Hong-Zhang Guo
- People's Hospital of Gansu Province, Chengguan District, 204 Donggang West Road, Lanzhou, 730000, China.
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Hourlier H, Fennema P. An observational study of an adjusted patient blood management protocol intended to lower rates of transfusion following total knee arthroplasty in patients with preoperative anemia. J Orthop Surg Res 2023; 18:918. [PMID: 38041115 PMCID: PMC10693030 DOI: 10.1186/s13018-023-04404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Patients with preoperative anemia have a higher risk of requiring blood transfusion after major orthopedic surgery due to increased blood loss and closer transfusion thresholds. Various patient blood management (PBM) policies aim to reduce transfusion rates. This observational study aimed to investigate blood loss and evaluate the effectiveness of an adjusted surgical PBM protocol in patients with anemic chronic disease (ACD) undergoing elective total knee arthroplasty (TKA). METHODS A consecutive cohort of patients underwent elective unilateral TKA with an adjusted PBM protocol. The protocol consisted of epoetin (EPO) alfa therapy prescribed by the surgeon, routine administration of tranexamic acid (TXA), and standardized postoperative pharmacologic prophylaxis for thromboembolism. The performance of this PBM protocol was analyzed in patients with a baseline hemoglobin level of less than 12 g/dl. Hemoglobin levels were controlled at admission, on postoperative day (POD) 1, and on POD 7 ± 1. A bleeding index (BI-7) was used as an estimate of blood loss up until POD 7. Multiple linear regression was used to assess whether there were any differences in BI-7 between ACD- and ACD + patients. RESULTS A total of 751 patients with complete hemoglobin monitoring were included in the study. Of these patients, 68 (9.1%) had a baseline hemoglobin concentration of less than 12 g/dl (ACD group). In this group, 28 patients (41.2%) received preoperative EPO therapy. The mean adjusted BI-7 for the study population was 3.0 (95% CI, 2.9 to 3.0) g/dl in the ACD- group and 2.3 (95% CI, 2.0-2.6) g/dl in the ACD + group. The difference in BI-7 was statistically significant (difference, 0.6 [95% CI: 0.3 to 0.9] g/dl, p < 0.001). No major complications occurred in the ACD + group, whereas there were three complications in the ACD- group (p = 1.00). CONCLUSIONS ACD patients undergoing TKA did not have an increased risk of bleeding or bleeding complications with the use of the adjusted PBM protocol. None of ACD patients required transfusion. ACD patients undergoing TKA experienced significantly less blood loss than patients with no preoperative anemia with the use of the adjusted PBM. We now consider the use of EPO in ACD patients with no nutritional deficiencies undergoing TKA at a baseline hemoglobin level of 11 g/dl. However, this should be validated in larger cohorts with a higher prevalence of ACD patients.
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Affiliation(s)
- Hervé Hourlier
- Department of Orthopaedic Surgery, Polyclinique de La Thiérache, Rue du Dr Koral, 59212, Wignehies, France.
- Centre Hospitalier de Fourmies, 59610, Fourmies, France.
| | - Peter Fennema
- AMR Advanced Medical Research GmbH, Männedorf, Switzerland
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Jin X, Liang W, Zhang L, Cao S, Yang L, Xie F. Economic and Humanistic Burden of Osteoarthritis: An Updated Systematic Review of Large Sample Studies. PHARMACOECONOMICS 2023; 41:1453-1467. [PMID: 37462839 DOI: 10.1007/s40273-023-01296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE A previous systematic literature review demonstrated a significant economic and humanistic burden on patients with osteoarthritis (OA). The aim of this study was to systematically review and update the burden of OA reported by large sample studies since 2016. METHODS We searched Medline (via Ovid) and Embase using the updated search strategy based on the previous review. Those studies with a sample size ≥ 1000 and measuring the cost (direct or indirect) or health-related quality of life (HRQL) of OA were included. Pairs of reviewers worked independently and in duplicate. An arbitrator was consulted to resolve discrepancies between reviewers. The Kappa value was calculated to examine the agreement between reviewers. All costs were converted to 2021 US dollars according to inflation rates and exchange rates. RESULTS A total of 1230 studies were screened by title and abstract and 159 by full text, and 54 studies were included in the review. The Kappa value for the full-text screening was 0.71. Total annual OA-related direct costs ranged from US$326 in Japan to US$19,530 in the US. Total annual all-cause direct costs varied from US$173 in Italy to US$41,433 in the US. The annual indirect costs ranged from US$736 in the US to US$18,884 in the Netherlands. Thirty-four studies reported HRQL, with EQ-5D (13, 38%) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (6, 18%) being the most frequently used instruments. The EQ-VAS and utility scores ranged from 41.5 to 81.7 and 0.3 to 0.9, respectively. The ranges of WOMAC pain (range 0-20, higher score for worse health), stiffness (range 0-8), and physical functioning (range 0-68) were 2.0-3.0, 1.0-5.0, and 5.8-42.8, respectively. CONCLUSION Since 2016, the ranges of direct costs of OA became wider, while the HRQL of patients remained poor. More countries outside the US have published OA-related disease burden using registry databases.
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Affiliation(s)
- Xuejing Jin
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Wanxian Liang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Lining Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Shihuan Cao
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Lujia Yang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Centre for Health Economics and Policy Analysis, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
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Pavão DM, Heringer EM, Almeida GJ, de Faria JLR, Pires e Albuquerque RS, de Sousa EB, Labronici PJ. Predictive and protective factors for allogenic blood transfusion in total knee arthroplasty. A retrospective cohort study. J Orthop 2023; 40:29-33. [PMID: 37159823 PMCID: PMC10163608 DOI: 10.1016/j.jor.2023.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
Background This study aimed to identify the predictive and protective factors of blood transfusion in patients undergoing total knee arthroplasty (TKA) and therefore determine the profile of patients with low and high risk of blood transfusion after arthroplasty. Methods We conducted a retrospective study with all patients who underwent primary TKA between January 2017 and December 2019 (n = 1.028 patients) in our institution. Information about allogenic transfusion was collected from medical records to determine the incidence, the predictive and protective factors of blood transfusion. All cases of blood transfusions were documented as well the number of units and the moment of each transfusion. We performed univariate and multivariate logistic regression analyses to identify the independent risk and protective factors. Results The total transfusion rate was 11%, 1.1% at intraoperative and 9,9% at postoperative period. The independent risk factors for transfusion were female gender (OR 1.64), older age (>55yo, OR > 2) higher surgical risk (ASA III, OR 3.07), lower preoperative hemoglobin levels (p = 0.024), post-traumatic arthritis (OR 4.11) and use of postoperative drains (OR 1.81) The protective factors for transfusion were male gender (OR 0.60), obesity (IMC >30, OR 0.60) and use of intravenous tranexamic acid intraoperatively (OR 0.40). Conclusions We conclude that in addition to the well-established risk factors for blood transfusion such as advanced age, low hemoglobin levels and high surgical risk, we can add post-fracture arthroplasty, non-use of tranexamic acid and the use of postoperative joint drain.
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Affiliation(s)
- Douglas Mello Pavão
- National Institute of Traumatology and Orthopaedics (INTO), Rio de Janeiro, Brazil
- Federal Fluminense University (UFF), Niteroi, Brazil
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Robertson FM, Clement ND. Preoperative Anemia Is Associated With Worse Joint-Specific Postoperative Outcomes, but Is Not Associated With Health-Related Quality of Life or Patient Satisfaction After Total Knee Arthroplasty. J Arthroplasty 2023; 38:51-59. [PMID: 35921998 DOI: 10.1016/j.arth.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The primary aim assessed whether preoperative anemia was associated with a worse knee-specific functional outcome after total knee arthroplasty (TKA). The secondary aims assessed the association of preoperative anemia with generic health and patient satisfaction. METHODS A retrospective cohort study was undertaken to compare patients who did and did not have anemia (Hb <13.0 g/dL for men and Hb <11.5 g/dL for women). During a 1-year period, 497 patients underwent a total knee arthroplasty with complete preoperative and postoperative data, including 215 (43.3%) men and 282 (56.7%) women, who had a mean age of 70 years (range 45-93). Patient demographics, comorbidities, preoperative and postoperative (1 year) Oxford Knee Score (OKS), EuroQol 5 dimension (EQ-5D), postoperative Forgotten Joint Score (FJS), and patient satisfaction were collected. Regression analyses were used to adjust for confounding factors between the groups. RESULTS The 56 (11.3%) patients who had anemia were older (4.6 years, P < .001) and more likely to have chronic obstructive pulmonary disease (P = .004), connective tissue (P = .047), or kidney disease (P = .011) compared to those who did not have anemia. There were no differences in the preoperative OKS (P = .752) or EQ-5D (P = .762) scores between the groups. When adjusting for confounding differences, there was a significantly lower postoperative OKS (-3.0 points, P = .035) and FJS (-11.6 points, P = .011) associated with the anemia group. There were no significant differences in the EQ-5D (P = .118) or patient satisfaction between groups (odds ratio 0.84, P = .976). CONCLUSION Preoperative anemia is associated with a lower postoperative joint-specific functional outcome. It is not clear if these differences are clinically meaningful. No difference in patient satisfaction was observed. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Fabienne M Robertson
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas D Clement
- Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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6
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Hu RT, Royse AG, Royse C, Scott DA, Bowyer A, Boggett S, Summers P, Mazer CD. Health-related quality of life after restrictive versus liberal RBC transfusion for cardiac surgery: Sub-study from a randomized clinical trial. Transfusion 2022; 62:1973-1983. [PMID: 36066319 DOI: 10.1111/trf.17084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transfusion Requirements in Cardiac Surgery III (TRICS III), a multi-center randomized controlled trial, demonstrated clinical non-inferiority for restrictive versus liberal RBC transfusion for patients undergoing cardiac surgery. However, it is uncertain if transfusion strategy affects long-term health-related quality of life (HRQOL). STUDY DESIGN AND METHODS In this planned sub-study of Australian patients in TRICS III, we sought to determine the non-inferiority of restrictive versus liberal transfusion strategy on long-term HRQOL and to describe clinical outcomes 24 months postoperatively. The restrictive strategy involved transfusing RBCs when hemoglobin was <7.5 g/dl; the transfusion triggers in the liberal group were: <9.5 g/L intraoperatively, <9.5 g/L in intensive care, or <8.5 g/dl on the ward. HRQOL assessments were performed using the 36-item short form survey version 2 (SF-36v2). Primary outcome was non-inferiority of summary measures of SF-36v2 at 12 months, (non-inferiority margin: -0.25 effect size; restrictive minus liberal scores). Secondary outcomes included non-inferiority of HRQOL at 18 and 24 months. RESULTS Six hundred seventeen Australian patients received allocated randomization; HRQOL data were available for 208/311 in restrictive and 217/306 in liberal group. After multiple imputation, non-inferiority of restrictive transfusion at 12 months was not demonstrated for HRQOL, and the estimates were directionally in favor of liberal transfusion. Non-inferiority also could not be concluded at 18 and 24 months. Sensitivity analyses supported these results. There were no differences in quality-adjusted life years or composite clinical outcomes up to 24 months after surgery. DISCUSSION The non-inferiority of a restrictive compared to a liberal transfusion strategy was not established for long-term HRQOL in this dataset.
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Affiliation(s)
- Raymond T Hu
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Alistair G Royse
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Colin Royse
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Outcomes Research Consortium, The Cleveland Clinic, Cleveland, Ohio, USA
| | - David A Scott
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Andrea Bowyer
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Stuart Boggett
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Peter Summers
- Statistical Consulting Centre, University of Melbourne, Parkville, Victoria, Australia.,Melbourne Disability Institute, University of Melbourne, Parkville, Victoria, Australia.,Centre for Health Analytics, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Cyril David Mazer
- Department of Anaesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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7
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Cao G, Yang X, Xu H, Yue C, Huang Z, Zhang S, Quan S, Yao J, Yang M, Pei F. Association between preoperative hemoglobin and postoperative moderate and severe anemia among patients undergoing primary total knee arthroplasty: a single-center retrospective study. J Orthop Surg Res 2021; 16:572. [PMID: 34565418 PMCID: PMC8474733 DOI: 10.1186/s13018-021-02727-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/13/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Postoperative moderate and severe anemia (PMSA) has been a serious perioperative complication in primary total knee arthroplasty (TKA). However, the ideal cutoff values to predict PMSA is still undetermined. The aim of this study was (1) to identify the risk factors associated with PMSA and (2) to establish the cutoff values of preoperative hemoglobin (HB) associated with increased PMSA in primary TKA. METHODS We identified 474 patients undergoing primary TKA and separated those in which PMSA (HB was less than 110 g/L on postoperative day 1 and 3) was developed from those without PMSA. Multivariate logistic regression model was used to identify independent risk factors for PMSA. Area under the receiver-operator curve (AUC) was used to determine the best-supported preoperative HB cutoff across all the patients. RESULTS The PMSA rate in primary TKA was 53.2%. Significant risk factors were lower preoperative HB (OR [odds ratio] = 1.138, 95% CI [confidence interval] = 1.107-1.170, p < 0.001) and more intraoperative blood loss (OR = 1.022, 95% CI 1.484-4.598, p < 0.001). A preoperative HB cutoff value that maximized the AUC was 138.5 g/L for men (sensitivity: 79.4%, specificity: 75.0%) and 131.5 g/L for women (sensitivity: 74.7%, specificity: 80.5%), respectively. CONCLUSION We should recognize and consider the related risk factors to establish specific, personalized risk assessment for PMSA, including preoperative HB and intraoperative blood loss. Of these, preoperative HB was a referable tool to predict PMSA in primary TKA.
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Affiliation(s)
- Guorui Cao
- Department of Knee Injury (2), Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Xiuli Yang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 87 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 87 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Chen Yue
- Department of Knee Injury (2), Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Zeyu Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 87 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Shaoyun Zhang
- Department of Orthopedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, 621000, Sichuan Province, People's Republic of China
| | - Songtao Quan
- Department of Knee Injury (2), Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Junna Yao
- Department of Knee Injury (2), Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Minglu Yang
- Department of Knee Injury (2), Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, 471000, Henan Province, People's Republic of China
| | - Fuxing Pei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 87 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
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Scrimshire AB, Booth A, Fairhurst C, Kotze A, Reed M, McDaid C. Preoperative iron treatment in anaemic patients undergoing elective total hip or knee arthroplasty: a systematic review and meta-analysis. BMJ Open 2020; 10:e036592. [PMID: 33130561 PMCID: PMC7783611 DOI: 10.1136/bmjopen-2019-036592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Preoperative anaemia is associated with increased risks of postoperative complications, blood transfusion and mortality. This meta-analysis aims to review the best available evidence on the clinical effectiveness of preoperative iron in anaemic patients undergoing elective total hip (THR) or total knee replacement (TKR). DESIGN Electronic databases and handsearching were used to identify randomised and non-randomised studies of interventions (NRSI) reporting perioperative blood transfusion rates for anaemic participants receiving iron before elective THR or TKR. Searches of CENTRAL, MEDLINE, Embase, PubMed and other databases were conducted on 17 April 2019 and updated on 15 July 2020. Two investigators independently reviewed studies for eligibility and evaluated risk of bias using the Cochrane risk of bias tool for randomised controlled trials (RCTs) and a modified Newcastle-Ottawa scale for NRSIs. Data extraction was performed by ABS and checked by AB. Meta-analysis used the Mantel-Haenszel method and random-effects models. RESULTS 807 records were identified: 12 studies met the inclusion criteria, of which 10 were eligible for meta-analyses (one RCT and nine NRSIs). Five of the NRSIs were of high-quality while there were some concerns of bias in the RCT. Meta-analysis of 10 studies (n=2178 participants) showed a 39% reduction in risk of receiving a perioperative blood transfusion with iron compared with no iron (risk ratio 0.61, 95% CI 0.50 to 0.73, p<0.001, I2=0%). There was a significant reduction in the number of red blood cell units transfused with iron compared with no iron (mean difference -0.37units, 95% CI -0.47 to -0.27, p<0.001, I2=40%); six studies (n=1496). Length of stay was significantly reduced with iron, by an average of 2.08 days (95% CI -2.64 to -1.51, p<0.001, I2=40%); five studies (n=1140). CONCLUSIONS Preoperative iron in anaemic, elective THR or TKR patients, significantly reduces the number of patients and number of units transfused and length of stay. However, high-quality, randomised trials are lacking. PROSPERO REGISTRATION NUMBER CRD42019129035.
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Affiliation(s)
- Ashley B Scrimshire
- Department of Health Sciences, University of York, York, UK
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK
| | - Alison Booth
- Department of Health Sciences, University of York, York, UK
| | | | | | - Mike Reed
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK
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10
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Villa JC, Koressel J, van der List JP, Cohn M, Wellman DS, Lorich DG, Lane JM. Predictors of In-Hospital Ambulatory Status Following Low-Energy Hip Fracture Surgery. Geriatr Orthop Surg Rehabil 2019; 10:2151459318814825. [PMID: 30671280 PMCID: PMC6328945 DOI: 10.1177/2151459318814825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction: Twenty-five percent to seventy-five percent of independent patients do not walk independently after hip fracture (HF), and many patients experience functional loss. Early rehabilitation of functional status is associated with better long-term outcomes; however, predictors of early ambulation after HF have not been well described. Purposes: To assess the impact of perioperative and patient-specific variables on in-hospital ambulatory status following low-energy HF surgery. Methods: This is a retrospective analysis of 463 geriatric patients who required HF surgery at a metropolitan level-1 trauma center. The outcomes were time to transfer (out of bed to chair) and time to walk. Results: Three hundred ninety-two (84.7%) patients were able to transfer after surgery with a median time of 43.8 hours (quartile range: 24.7-53.69 hours), while 244 (52.7%) patients were able to walk with a median time of 50.86 hours (quartile range: 40.72-74.56 hours). Preinjury ambulators with aids (hazard ratio [HR]: 0.70, confidence interval [CI]: 0.50-0.99), age >80 years (HR: 0.66, CI: 0.52-0.84), peptic ulcer disease (HR: 0.57, CI: 0.57-0.82), depression (HR: 0.66, CI: 0.49- 0.89), time to surgery >24 hours (HR: 0.77, CI: 0.61-0.98), and surgery on Friday (HR: 0.73, CI: 0.56-0.95) were associated with delayed time to transfer. Delayed time to walk was observed in patients over 80 years old (HR: 0.74, CI: 0.56-0.98), females (HR: 0.67, CI: 0.48-0.94), peptic ulcer disease (HR: 0.23, CI: 0.84-0.66), and depression (HR: 0.51, CI: 0.33-0.77). Conclusions: Operative predictors of delayed time to transfer were surgery on Friday and time to surgery >24 hours after admission. Depression is associated with delayed time to transfer and time to walk. These data suggest that is important to perform surgeries within 24 hours of admission identify deficiencies in care during the weekends, and create rehabilitation programs specific for patient with depression. Improving functional rehabilitation after surgery may facilitate faster patient discharge, decrease inpatient care costs, and better long-term functional outcomes.
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Affiliation(s)
- Jordan C Villa
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA.,New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Joseph Koressel
- Orthopaedic Trauma Service, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | | | - Matthew Cohn
- Orthopaedic Trauma Service, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - David S Wellman
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA.,Orthopaedic Trauma Service, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Dean G Lorich
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA.,Orthopaedic Trauma Service, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Joseph M Lane
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA.,Orthopaedic Trauma Service, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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