Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia

Comparison of the effect of open-box versus closed-box prostheses on blood loss following total knee arthroplasty: a meta-analysis

Purpose

Postoperative blood loss is a common complication following total knee arthroplasty (TKA). The authors aimed to analyze the significance of open versus closed-box prostheses in reducing blood loss after TKA.

Methods

PubMed, Cochrane, Scopus, and Web of Science were searched. Observational studies and clinical trials comparing the effect of open-box versus closed-box prostheses on blood loss following TKA were included. The primary outcome was total blood loss following TKA. Secondary outcomes included average transfused units and total operation time. Continuous data were represented as mean difference (MD) and CI, while dichotomous data were presented as odds ratio (OR) and CI. RevMan software version 5.4 was used to conduct the analysis.

Results

Four studies with a total number of 687 patients were included. The pooled analysis showed a statistically significant association between closed-box and decreased total blood loss following TKA compared with open-box (MD=173.19, 95% CI=88.77-257.61, P value <0.0001). Similar findings were reported in unilateral TKA (MD=190.63, 95% CI=70.91-310.35, P value=0.002), and bilateral TKA (MD=160.79, 95% CI=61.70-359.86, P value=0.001). There was no significant difference between open and closed-box regarding average transfused units (MD=0.02, 95% CI=-0.07-0.11, P value=0.68), blood transfusion rate (OR=1.38, 95% CI=0.85-2.26, P value=0.20), length of stay (MD=0.06, 95% CI=-0.27 to 0.38, P value=0.74), and total operation time (MD=1.08, 95% CI=-4.62 to 6.79, P value=0.71).

Conclusion

Closed-box reduces the total blood loss following unilateral and bilateral TKA. More studies are warranted to explore the benefits of Closed-box in patients with high bleeding susceptibility.

Predictive and protective factors for allogenic blood transfusion in total knee arthroplasty. A retrospective cohort study

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.

Immediate haemoglobin testing in association with a dedicated anaemia clinic: Effectiveness for primary total knee replacement patients

INTRODUCTION

Preoperative anaemia is associated with higher transfusion rates, increased hospital stays and poorer outcomes. Addressing preoperative anaemia is a crucial pillar of Patient Blood Management. Conventionally, patients are listed for surgery and then screened for anaemia in the pre-assessment clinic, followed by referral to their general practitioner. This process involves substantial delays, and poorly treated anaemia often results in perioperative transfusions. We assessed our pathway of immediate haemoglobin testing at the time of listing in conjunction with a dedicated preoperative anaemia clinic for detecting and treating anaemia in primary total knee replacement patients.

MATERIALS AND METHODS

We compared transfusion rates between anaemic patients undergoing a primary total knee replacement who were treated in this pathway with those who were not. We reviewed the preoperative haemoglobin levels, transfusion rates and treatment for all primary total knee arthroplasty patients over three years amounting to 2296.

RESULTS

Transfusion rates were significantly lower in the group treated in this pathway compared to those who were not. The treated group also had significantly higher preoperative haemoglobin levels.Discussion and conclusion: Immediate haemoglobin testing in association with a dedicated preoperative anaemia clinic is effective at detecting and treating anaemia in primary total knee replacement patients and reduces transfusion requirements.

An insight into the utilization of allogenic blood transfusion and factors affecting blood transfusion in total knee replacement surgery in a tertiary care hospital in Eastern India

BACKGROUND:

Significant blood loss and requirement of allogenic blood transfusion during or after total knee replacement (TKR) have been reported. Incidence of blood transfusion in TKR is highly variable and depends on several factors. We investigated the blood utilization in patients undergoing TKR in our hospital and depicted the important risk factors that determine the need of allogenic blood transfusion in primary unilateral TKR.

MATERIALS AND METHODS:

The study included 1241 consecutive patients undergoing primary unilateral total knee arthroplasty. All the surgeries were performed by a single surgical team of orthopedists following standard procedure. Patient and disease details were obtained from patient file and hospital information system. Compatibility test was performed in blood bank before blood reservation following mandatory guidelines. Details of test, blood issue, and blood transfusion were documented in the blood bank.

RESULTS:

Of 1241 enrolled patients, 1069 (86.2%) were female. The median age of patients was 66 years with mean preoperative hemoglobin of 9.9 g/dL. Allogenic blood transfused was needed in 223 (17.9%) patients. Diabetes mellitus, hypertension, thyroid disorders, and chronic heart diseases were the major comorbid conditions. Risk factors such as gender, American Society of Anesthesiologists score, preoperative hemoglobin, and intraoperative and postoperative blood losses were significantly associated with blood transfusion.

CONCLUSION:

The risk factors determining blood transfusion in TKR vary between studies, however, all centers should establish standard operating procedures describing the surgical procedure and transfusion support in TKR. In addition, each center may develop specific blood management strategy to rationalize blood transfusion in TKR and overall successful care in TKR.

Blood loss and transfusion risk in robotic-assisted knee arthroplasty: A retrospective analysis

BACKGROUND

The purpose of this study was to compare total blood loss and the risk of receiving a blood transfusion in robotic-assisted total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) against conventional jig-based techniques.

METHODS

Robotic TKA (n = 50) and UKA (n = 50) patients were matched to contemporary controls for TKA (n = 50) and UKA (n = 50) and retrospectively analysed.

RESULTS

Robotic TKA patients experienced 23.7% less blood loss compared to conventional TKA patients (911.0 ml vs 1193.7 ml, p < 0.01), and were associated with an 83% relative risk reduction of receiving a transfusion (2% of patients vs 12%, p = 0.02). Robotic UKA patients did not demonstrate less blood loss compared to corresponding controls (821.7 ml vs 854.7 ml, p = 0.69). Both UKA groups received no transfusions.

CONCLUSIONS

Robotic surgical systems in TKA reduces blood loss and lowers the risk of requiring a blood transfusion. In UKA, robotic-assisted arthroplasty did not reduce blood loss compared to conventional arthroplasty.

The incidence and risk factors for allogenic blood transfusion in total knee and hip arthroplasty

Background

Excessive blood loss in total joint arthroplasty (TJA) usually leads to an allogenic blood transfusion, which may cause adverse outcomes, prolonged length of hospitalization, and increased costs. The purpose of this study was to determine the incidence and risk factors for intraoperative and postoperative allogenic transfusion in patients undergoing primary unilateral total knee and hip arthroplasty (TKA and THA).

Methods

We conducted a retrospective study and enrolled consecutive patients undergoing primary unilateral TKA and THA at our institution between January 2010 and July 2014 (n = 1534). Information about allogenic transfusion was collected from medical records to determine the incidence. We performed univariate analysis and multivariate logistic regression analysis to identify the independent risk factors.

Results

Total, intraoperative, and postoperative transfusion rates were 17.9%, 7.9%, and 11.3%, respectively. The preoperative lower level of hemoglobin (Hb) (P < 0.001) and increased amount of intraoperative blood loss (P < 0.001) were independently associated with transfusion in TKA. The independent risk factors for transfusion in THA were female (P = 0.023), preoperative lower Hb level (P < 0.001), prolonged operation time (P < 0.001), and increased intraoperative blood loss (P < 0.001).

Conclusions

Given the high prevalence and potential risk of transfusion in TJA, interventions for identified risk factors should be used during the perioperative period.