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Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors
Introduction Accurate identification of patients at risk of blood transfusion can reduce complications and improve institutional resource allocation. Probabilistic models are used to detect risk factors and formulate patient blood management strategies. Whether these predictors vary among institutio...
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| Published in: | Archives of orthopaedic and trauma surgery 2022-08, Vol.142 (8), p.1817-1822 |
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| container_title | Archives of orthopaedic and trauma surgery |
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| creator | Erben, Hans-Christoph Hess, Florian Welter, JoEllen Graf, Nicole Steurer, Marc P. Neff, Thomas A. Zettl, Ralph Dullenkopf, Alexander |
| description | Introduction
Accurate identification of patients at risk of blood transfusion can reduce complications and improve institutional resource allocation. Probabilistic models are used to detect risk factors and formulate patient blood management strategies. Whether these predictors vary among institutions is unclear. We aimed to identify risk factors among our patients who underwent total hip (THA) or knee (TKA) arthroplasty, and combine these predictors to improve our model.
Materials and methods
We retrospectively assessed risk factors among 531 adults who underwent elective THA or TKA from January 2016 to November 2018. Using relevant surgical and patient characteristics gathered from electronic medical records, we conducted univariable and multivariable analyses. For our logistic regression model, we measured the impact of independent variables (age, gender, operation type (THA or TKA) and preoperative hemoglobin concentration) on the need for a transfusion.
Results
Of the 531 patients, 321 had THA (uncemented) and 210 had TKA. For the selected period, our transfusion rate of 8.1% (10.6% THA and 4.3% TKA) was low. Univariable analyses showed that lower BMI (
p
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| doi_str_mv | 10.1007/s00402-021-03763-w |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2491946623</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2491946623</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-b14ef28a9aa1d396b5fe047961924e4998a5a12ceaa0895054f0ba8aceec4d4d3</originalsourceid><addsrcrecordid>eNp9kctu1jAQRi0EoqXwAiyQJTZsQn2L_5gdqrhJlcoC1tbEmVC3iR08Tqu-fUP_chGLrsbSnPlmrMPYSyneSiF2xySEEaoRSjZC76xurh-xQ2m0abST9vE_7wP2jOhCCKk6J56yA62tsKJrD1n5iiXmBQvUeIW8n3IeeC2QaFwp5kQ8Jn4eFw5p4JcJkUOp5yUvE1C9eceBF6wl04LhLgCIkGjGVHkeechzHxMOvES65COEmgs9Z09GmAhf3Ncj9v3jh28nn5vTs09fTt6fNkHv2tr00uCoOnAActDO9u2IwuyclU4ZNM510IJUAQFE51rRmlH00EFADGYwgz5ib_a5S8k_V6Tq50gBpwkS5pW8Mk46Y63SG_r6P_QiryVt13llnWy3ZU5tlNpTYfswFRz9UuIM5cZL4X8Z8XsjfjPi74z4623o1X302s84_Bn5rWAD9B6grZV-YPm7-4HYW473mT4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2691599892</pqid></control><display><type>article</type><title>Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors</title><source>Springer Link</source><creator>Erben, Hans-Christoph ; Hess, Florian ; Welter, JoEllen ; Graf, Nicole ; Steurer, Marc P. ; Neff, Thomas A. ; Zettl, Ralph ; Dullenkopf, Alexander</creator><creatorcontrib>Erben, Hans-Christoph ; Hess, Florian ; Welter, JoEllen ; Graf, Nicole ; Steurer, Marc P. ; Neff, Thomas A. ; Zettl, Ralph ; Dullenkopf, Alexander</creatorcontrib><description>Introduction
Accurate identification of patients at risk of blood transfusion can reduce complications and improve institutional resource allocation. Probabilistic models are used to detect risk factors and formulate patient blood management strategies. Whether these predictors vary among institutions is unclear. We aimed to identify risk factors among our patients who underwent total hip (THA) or knee (TKA) arthroplasty, and combine these predictors to improve our model.
Materials and methods
We retrospectively assessed risk factors among 531 adults who underwent elective THA or TKA from January 2016 to November 2018. Using relevant surgical and patient characteristics gathered from electronic medical records, we conducted univariable and multivariable analyses. For our logistic regression model, we measured the impact of independent variables (age, gender, operation type (THA or TKA) and preoperative hemoglobin concentration) on the need for a transfusion.
Results
Of the 531 patients, 321 had THA (uncemented) and 210 had TKA. For the selected period, our transfusion rate of 8.1% (10.6% THA and 4.3% TKA) was low. Univariable analyses showed that lower BMI (
p
< 0.001) was associated with receiving a transfusion. Important factors identified through logistic regression analyses were age (estimated effect of an interquartile range increase in age: OR 3.89 [CI 95% 1.96–7.69]), TKA (OR − 0.77 [CI 95% − 1.57–0.02]), and preoperative hemoglobin levels (estimated effect of interquartile range increase in hemoglobin: OR 0.47 [CI 95% 0.31–0.71]). Contrary to findings from previous reports, gender was not associated with transfusion.
Conclusions
Previously published predictors such as advanced age, low preoperative hemoglobin, and procedure type (THA) were also identified in our analysis. However, gender was not a predictor, and BMI showed the potential to influence risk. We conclude that, when feasible, the determination of site-specific transfusion rates and combined risk factors can assist practitioners to customize care according to the needs of their patient population.
Level of evidence
Level 3, retrospective cohort study</description><identifier>ISSN: 1434-3916</identifier><identifier>ISSN: 0936-8051</identifier><identifier>EISSN: 1434-3916</identifier><identifier>DOI: 10.1007/s00402-021-03763-w</identifier><identifier>PMID: 33606085</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Blood transfusions ; Gender ; Hemoglobin ; Joint surgery ; Medicine ; Medicine & Public Health ; Orthopaedic Surgery ; Orthopedics ; Patients ; Risk factors</subject><ispartof>Archives of orthopaedic and trauma surgery, 2022-08, Vol.142 (8), p.1817-1822</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature 2021</rights><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-b14ef28a9aa1d396b5fe047961924e4998a5a12ceaa0895054f0ba8aceec4d4d3</citedby><cites>FETCH-LOGICAL-c375t-b14ef28a9aa1d396b5fe047961924e4998a5a12ceaa0895054f0ba8aceec4d4d3</cites><orcidid>0000-0002-1456-6457</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33606085$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Erben, Hans-Christoph</creatorcontrib><creatorcontrib>Hess, Florian</creatorcontrib><creatorcontrib>Welter, JoEllen</creatorcontrib><creatorcontrib>Graf, Nicole</creatorcontrib><creatorcontrib>Steurer, Marc P.</creatorcontrib><creatorcontrib>Neff, Thomas A.</creatorcontrib><creatorcontrib>Zettl, Ralph</creatorcontrib><creatorcontrib>Dullenkopf, Alexander</creatorcontrib><title>Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors</title><title>Archives of orthopaedic and trauma surgery</title><addtitle>Arch Orthop Trauma Surg</addtitle><addtitle>Arch Orthop Trauma Surg</addtitle><description>Introduction
Accurate identification of patients at risk of blood transfusion can reduce complications and improve institutional resource allocation. Probabilistic models are used to detect risk factors and formulate patient blood management strategies. Whether these predictors vary among institutions is unclear. We aimed to identify risk factors among our patients who underwent total hip (THA) or knee (TKA) arthroplasty, and combine these predictors to improve our model.
Materials and methods
We retrospectively assessed risk factors among 531 adults who underwent elective THA or TKA from January 2016 to November 2018. Using relevant surgical and patient characteristics gathered from electronic medical records, we conducted univariable and multivariable analyses. For our logistic regression model, we measured the impact of independent variables (age, gender, operation type (THA or TKA) and preoperative hemoglobin concentration) on the need for a transfusion.
Results
Of the 531 patients, 321 had THA (uncemented) and 210 had TKA. For the selected period, our transfusion rate of 8.1% (10.6% THA and 4.3% TKA) was low. Univariable analyses showed that lower BMI (
p
< 0.001) was associated with receiving a transfusion. Important factors identified through logistic regression analyses were age (estimated effect of an interquartile range increase in age: OR 3.89 [CI 95% 1.96–7.69]), TKA (OR − 0.77 [CI 95% − 1.57–0.02]), and preoperative hemoglobin levels (estimated effect of interquartile range increase in hemoglobin: OR 0.47 [CI 95% 0.31–0.71]). Contrary to findings from previous reports, gender was not associated with transfusion.
Conclusions
Previously published predictors such as advanced age, low preoperative hemoglobin, and procedure type (THA) were also identified in our analysis. However, gender was not a predictor, and BMI showed the potential to influence risk. We conclude that, when feasible, the determination of site-specific transfusion rates and combined risk factors can assist practitioners to customize care according to the needs of their patient population.
Level of evidence
Level 3, retrospective cohort study</description><subject>Blood transfusions</subject><subject>Gender</subject><subject>Hemoglobin</subject><subject>Joint surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopaedic Surgery</subject><subject>Orthopedics</subject><subject>Patients</subject><subject>Risk factors</subject><issn>1434-3916</issn><issn>0936-8051</issn><issn>1434-3916</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kctu1jAQRi0EoqXwAiyQJTZsQn2L_5gdqrhJlcoC1tbEmVC3iR08Tqu-fUP_chGLrsbSnPlmrMPYSyneSiF2xySEEaoRSjZC76xurh-xQ2m0abST9vE_7wP2jOhCCKk6J56yA62tsKJrD1n5iiXmBQvUeIW8n3IeeC2QaFwp5kQ8Jn4eFw5p4JcJkUOp5yUvE1C9eceBF6wl04LhLgCIkGjGVHkeechzHxMOvES65COEmgs9Z09GmAhf3Ncj9v3jh28nn5vTs09fTt6fNkHv2tr00uCoOnAActDO9u2IwuyclU4ZNM510IJUAQFE51rRmlH00EFADGYwgz5ib_a5S8k_V6Tq50gBpwkS5pW8Mk46Y63SG_r6P_QiryVt13llnWy3ZU5tlNpTYfswFRz9UuIM5cZL4X8Z8XsjfjPi74z4623o1X302s84_Bn5rWAD9B6grZV-YPm7-4HYW473mT4</recordid><startdate>20220801</startdate><enddate>20220801</enddate><creator>Erben, Hans-Christoph</creator><creator>Hess, Florian</creator><creator>Welter, JoEllen</creator><creator>Graf, Nicole</creator><creator>Steurer, Marc P.</creator><creator>Neff, Thomas A.</creator><creator>Zettl, Ralph</creator><creator>Dullenkopf, Alexander</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1456-6457</orcidid></search><sort><creationdate>20220801</creationdate><title>Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors</title><author>Erben, Hans-Christoph ; Hess, Florian ; Welter, JoEllen ; Graf, Nicole ; Steurer, Marc P. ; Neff, Thomas A. ; Zettl, Ralph ; Dullenkopf, Alexander</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-b14ef28a9aa1d396b5fe047961924e4998a5a12ceaa0895054f0ba8aceec4d4d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Blood transfusions</topic><topic>Gender</topic><topic>Hemoglobin</topic><topic>Joint surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopaedic Surgery</topic><topic>Orthopedics</topic><topic>Patients</topic><topic>Risk factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Erben, Hans-Christoph</creatorcontrib><creatorcontrib>Hess, Florian</creatorcontrib><creatorcontrib>Welter, JoEllen</creatorcontrib><creatorcontrib>Graf, Nicole</creatorcontrib><creatorcontrib>Steurer, Marc P.</creatorcontrib><creatorcontrib>Neff, Thomas A.</creatorcontrib><creatorcontrib>Zettl, Ralph</creatorcontrib><creatorcontrib>Dullenkopf, Alexander</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database (ProQuest)</collection><collection>PHMC-Proquest健康医学期刊库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of orthopaedic and trauma surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Erben, Hans-Christoph</au><au>Hess, Florian</au><au>Welter, JoEllen</au><au>Graf, Nicole</au><au>Steurer, Marc P.</au><au>Neff, Thomas A.</au><au>Zettl, Ralph</au><au>Dullenkopf, Alexander</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors</atitle><jtitle>Archives of orthopaedic and trauma surgery</jtitle><stitle>Arch Orthop Trauma Surg</stitle><addtitle>Arch Orthop Trauma Surg</addtitle><date>2022-08-01</date><risdate>2022</risdate><volume>142</volume><issue>8</issue><spage>1817</spage><epage>1822</epage><pages>1817-1822</pages><issn>1434-3916</issn><issn>0936-8051</issn><eissn>1434-3916</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Introduction
Accurate identification of patients at risk of blood transfusion can reduce complications and improve institutional resource allocation. Probabilistic models are used to detect risk factors and formulate patient blood management strategies. Whether these predictors vary among institutions is unclear. We aimed to identify risk factors among our patients who underwent total hip (THA) or knee (TKA) arthroplasty, and combine these predictors to improve our model.
Materials and methods
We retrospectively assessed risk factors among 531 adults who underwent elective THA or TKA from January 2016 to November 2018. Using relevant surgical and patient characteristics gathered from electronic medical records, we conducted univariable and multivariable analyses. For our logistic regression model, we measured the impact of independent variables (age, gender, operation type (THA or TKA) and preoperative hemoglobin concentration) on the need for a transfusion.
Results
Of the 531 patients, 321 had THA (uncemented) and 210 had TKA. For the selected period, our transfusion rate of 8.1% (10.6% THA and 4.3% TKA) was low. Univariable analyses showed that lower BMI (
p
< 0.001) was associated with receiving a transfusion. Important factors identified through logistic regression analyses were age (estimated effect of an interquartile range increase in age: OR 3.89 [CI 95% 1.96–7.69]), TKA (OR − 0.77 [CI 95% − 1.57–0.02]), and preoperative hemoglobin levels (estimated effect of interquartile range increase in hemoglobin: OR 0.47 [CI 95% 0.31–0.71]). Contrary to findings from previous reports, gender was not associated with transfusion.
Conclusions
Previously published predictors such as advanced age, low preoperative hemoglobin, and procedure type (THA) were also identified in our analysis. However, gender was not a predictor, and BMI showed the potential to influence risk. We conclude that, when feasible, the determination of site-specific transfusion rates and combined risk factors can assist practitioners to customize care according to the needs of their patient population.
Level of evidence
Level 3, retrospective cohort study</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33606085</pmid><doi>10.1007/s00402-021-03763-w</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-1456-6457</orcidid></addata></record> |
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| subjects | Blood transfusions Gender Hemoglobin Joint surgery Medicine Medicine & Public Health Orthopaedic Surgery Orthopedics Patients Risk factors |
| title | Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors |
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