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de Campos TF, Vertzyas N, Wolden M, Hewawasam D, Douglas B, McIllhatton C, Hili J, Molnar C, Solomon MI, Gass GC, Mungovan SF. Orthostatic Intolerance-Type Events Following Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2023; 105:239-249. [PMID: 36723468 DOI: 10.2106/jbjs.22.00600] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute hospital stay following hip and knee arthroplasty. METHODS A systematic review and meta-analysis of studies that investigated the incidence of and risk factors for OI-type events was undertaken. A comprehensive search was performed in MEDLINE, Embase, and CINAHL from their inception to October 2021. The methodological quality of identified studies was assessed using the modified version of the Quality in Prognosis Studies (QUIPS) tool. RESULTS Twenty-one studies (14,055 patients) were included. The incidence was 2% to 52% for an OI event, 1% to 46% for orthostatic hypotension, and 0% to 18% for syncope/vasovagal events. Two studies reported female sex, high peak pain levels (>5 out of 10) during mobilization, postoperative use of gabapentin, and the absence of postoperative intravenous dexamethasone as risk factors. There was no consensus on the definition and assessment of an OI-type event. CONCLUSIONS OI-type events are common during the acute hospital stay following hip and knee arthroplasty, and 4 risk factors have been reported for OI-type events. High-quality prospective cohort studies are required to systematically and reliably determine the incidence of and risk factors for OI-type events. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tarcisio F de Campos
- St Vincent's Private Hospital, Sydney, New South Wales, Australia.,St Vincent's Private Allied Health Services, St Vincent's Private Hospital, Sydney, New South Wales, Australia.,Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Nick Vertzyas
- Department of Orthopaedic Surgery, St Vincent's Private Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Mitch Wolden
- Physical Therapy Program, University of Jamestown, Fargo, North Dakota.,The Clinical Research Institute, Sydney, New South Wales, Australia
| | - Deshitha Hewawasam
- St Vincent's Private Allied Health Services, St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Ben Douglas
- St Vincent's Private Allied Health Services, St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Christopher McIllhatton
- St Vincent's Private Allied Health Services, St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Jessica Hili
- St Vincent's Private Allied Health Services, St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Chloe Molnar
- St Vincent's Private Allied Health Services, St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Michael I Solomon
- Department of Orthopaedic Surgery, St Vincent's Private Hospital, Sydney, New South Wales, Australia.,Sydney Orthopaedic Specialists, Sydney, New South Wales, Australia
| | - Gregory C Gass
- The Clinical Research Institute, Sydney, New South Wales, Australia
| | - Sean F Mungovan
- St Vincent's Private Allied Health Services, St Vincent's Private Hospital, Sydney, New South Wales, Australia.,Sydney Orthopaedic Specialists, Sydney, New South Wales, Australia.,Department of Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia
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OuYang CL, Hao XY, Yu Y, Lou JS, Cao JB, Yu YQ, Mi WD. Intraoperative allogeneic transfusion is associated with postoperative delirium in older patients after total knee and hip arthroplasty. Front Surg 2023; 9:1048197. [PMID: 36684187 PMCID: PMC9849749 DOI: 10.3389/fsurg.2022.1048197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023] Open
Abstract
Objective To determine whether intraoperative transfusion of allogeneic or autologous blood is associated with an increased incidence of postoperative delirium (POD) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods The medical records of 1,143 older (≥65 years old) patients who received an intraoperative blood transfusion while undergoing total knee or hip arthroplasty at the First Medical Center of Chinese PLA General Hospital from 2014 to 2019 were reviewed; of these patients, 742 (64.92%) received allogeneic blood, while 401 (35.08%) received autologous blood. Patients who received autologous transfusion were paired with those received allogeneic transfusion using 1:1 propensity score matching method. The primary outcome was POD. The secondary outcomes were postoperative complications, including heart failure, deep vein thrombosis, myocardial infarction, stroke, and lung infection. Multivariable nominal logistic regression was used to identify any independent associations between intraoperative blood transfusions and POD, and secondary postoperative complications, respectively. Results Postoperative delirium occurred in 6.6% (49/742) of patients who had received an allogeneic blood transfusion and in 2.0% (8/401) of patients who had received an autologous blood transfusion. It is noteworthy that the multivariable logistic regression demonstrated a significant association between intraoperative allogeneic blood transfusion and POD (odds ratio [OR]: 4.11; 95% confidence interval [CI]: 1.95-9.77; p < 0.001). After PSM, Allogeneic transfusion was also the strongest predictor for POD (OR: 4.43; 95% CI: 2.09-10.58; p < 0.001). Conclusions In the patients who had received THA or TKA, intraoperative allogeneic blood transfusions were associated with an increased risk of POD.
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Affiliation(s)
- Chun-lei OuYang
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China,Medical School of Chinese PLA, Beijing, China
| | - Xin-yu Hao
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China,Medical School of Chinese PLA, Beijing, China
| | - Yao Yu
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jing-sheng Lou
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Jiang-bei Cao
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Ying-qun Yu
- Department of Anesthesiology, The Fifth Medical Center of PLA General Hospital, Beijing, China,Correspondence: Wei-dong Mi Ying-qun Yu
| | - Wei-dong Mi
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China,Correspondence: Wei-dong Mi Ying-qun Yu
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Independent Association Between Type of Intraoperative Blood Transfusion and Postoperative Delirium After Complex Spinal Fusion for Adult Deformity Correction. Spine (Phila Pa 1976) 2020; 45:268-274. [PMID: 31996654 DOI: 10.1097/brs.0000000000003260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine whether type of intraoperative blood transfusion used is associated with increased incidence of postoperative delirium after complex spine fusion involving five levels or greater. SUMMARY OF BACKGROUND DATA Postoperative delirium after spine surgery has been associated with age, cognitive status, and several comorbidities. Intraoperative allogenic blood transfusions have previously been linked to greater complication risks and length of hospital stay. However, whether type of intraoperative blood transfusion used increases the risk for postoperative delirium after complex spinal fusion remains relatively unknown. METHODS The medical records of 130 adult (≥18 years old) spine deformity patients undergoing elective, primary complex spinal fusion (more than or equal to five levels) for deformity correction at a major academic institution from 2010 to 2015 were reviewed. We identified 104 patients who encountered an intraoperative blood transfusion. Of the 104, 15 (11.5%) had Allogenic-only, 23 (17.7%) had Autologous-only, and 66 (50.8%) had Combined transfusions. The primary outcome investigated was the rate of postoperative delirium. RESULTS There were significant differences in estimated blood loss (Combined: 2155.5 ± 1900.7 mL vs. Autologous: 1396.5 ± 790.0 mL vs. Allogenic: 1071.3 ± 577.8 mL vs. None: 506.9 ± 427.3 mL, P < 0.0001) and amount transfused (Combined: 1739.7 ± 1127.6 mL vs. Autologous: 465.7 ± 289.7 mL vs. Allogenic: 986.9 ± 512.9 mL, P < 0.0001). The Allogenic cohort had a significantly higher proportion of patients experiencing delirium (Combined: 7.6% vs. Autologous: 17.4% vs. Allogenic: 46.7% vs. None: 11.5%, P = 0.002). In multivariate nominal-logistic regression analysis, Allogenic (odds ratio [OR]: 24.81, 95% confidence interval [CI] [3.930, 156.702], P = 0.0002) and Autologous (OR: 6.43, 95% CI [1.156, 35.772], P = 0.0335) transfusions were independently associated with postoperative delirium. CONCLUSION Our study suggests that there may be an independent association between intraoperative autologous and allogenic blood transfusions and postoperative delirium after complex spinal fusion. Further studies are necessary to identify the physiological effect of blood transfusions to better overall patient care and reduce healthcare expenditures. LEVEL OF EVIDENCE 3.
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