Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort Study
Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis (OA) of the knee, because it alleviates pain and restores function of the knee. However, TKA-associated hemorrhage and subsequent anemia remain a concern. Most previous studies have defined meaningful postoperative...
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MDPI AG
2022-03-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/12/3/434 |
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| author | En-Bo Wu Kuo-Chuan Hung Sin-Ei Juang Jo-Chi Chin Hsiao-Feng Lu Jih-Yang Ko |
| author_facet | En-Bo Wu Kuo-Chuan Hung Sin-Ei Juang Jo-Chi Chin Hsiao-Feng Lu Jih-Yang Ko |
| author_sort | En-Bo Wu |
| collection | DOAJ |
| description | Total knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis (OA) of the knee, because it alleviates pain and restores function of the knee. However, TKA-associated hemorrhage and subsequent anemia remain a concern. Most previous studies have defined meaningful postoperative bleeding as blood loss > 500 mL or hemoglobin (Hb) drop > 20 g/L. Therefore, we defined significant hemorrhage as a postoperative Hb drop more than 20 g/L in this study, and we investigated possible risk factors related to significant hemorrhage in TKA and whether these risk factors are modifiable. This retrospective study was conducted through a comprehensive review of the perioperative records of patients with OA of the knee who underwent TKA between January 2009 and December 2015 at our hospital. Patients were allocated into two groups: patients in Group A had their Hb drop ≤ 20 g/L; patients in Group B had their Hb drop > 20 g/L. Factors analyzed included sex, age, body mass index (BMI), the American Society of Anesthesiologists (ASA) classification, comorbidities, preoperative platelet count, use of tranexamic acid (TXA), operation time, and type of anesthesia. A total of 3350 patients met the criteria for analysis, with 1782 patients allocated to Group A and 1568 patients to Group B. Five independent risk factors for significant hemorrhage were identified: male sex (odds ratio(OR), 1.29; 95% confidence interval(CI), 1.08–1.53; <i>p</i> = 0.005), age (OR, 1.02; 95% CI, 1.01–1.03; <i>p</i> = 0.001), use of TXA (OR, 0.39; 95% CI, 0.34–0.45; <i>p</i> < 0.001), spinal anesthesia versus general anesthesia (OR, 0.71; 95% CI, 0.56–0.90; <i>p</i> = 0.004), and preoperative platelet count (OR, 0.96; 95% CI, 0.93–0.98; <i>p</i> = 0.001). Of these identified risk factors, preoperative platelet count, use of TXA, and spinal anesthesia are modifiable. These potentially modifiable risk factors need to be taken into consideration when making both the perioperative care and anesthesia plan by surgeons and anesthesiologists, especially in patients at risk of significant hemorrhage. |
| first_indexed | 2024-03-09T13:39:48Z |
| format | Article |
| id | doaj.art-d724a0658c85436c9274ce6b3ea1d3ea |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T13:39:48Z |
| publishDate | 2022-03-01 |
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| spelling | doaj.art-d724a0658c85436c9274ce6b3ea1d3ea2023-11-30T21:08:25ZengMDPI AGJournal of Personalized Medicine2075-44262022-03-0112343410.3390/jpm12030434Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort StudyEn-Bo Wu0Kuo-Chuan Hung1Sin-Ei Juang2Jo-Chi Chin3Hsiao-Feng Lu4Jih-Yang Ko5Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, TaiwanDepartment of Anesthesiology, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City 710, TaiwanDepartment of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, TaiwanDepartment of Anesthesiology, Park One International Hospital, No. 100, Bo’ai 2nd Rd., Zuoying Dist., Kaohsiung City 813, TaiwanDepartment of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, TaiwanDepartment of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Rd., Niao-Song Dist., Kaohsiung City 833, TaiwanTotal knee arthroplasty (TKA) is the treatment of choice for end-stage osteoarthritis (OA) of the knee, because it alleviates pain and restores function of the knee. However, TKA-associated hemorrhage and subsequent anemia remain a concern. Most previous studies have defined meaningful postoperative bleeding as blood loss > 500 mL or hemoglobin (Hb) drop > 20 g/L. Therefore, we defined significant hemorrhage as a postoperative Hb drop more than 20 g/L in this study, and we investigated possible risk factors related to significant hemorrhage in TKA and whether these risk factors are modifiable. This retrospective study was conducted through a comprehensive review of the perioperative records of patients with OA of the knee who underwent TKA between January 2009 and December 2015 at our hospital. Patients were allocated into two groups: patients in Group A had their Hb drop ≤ 20 g/L; patients in Group B had their Hb drop > 20 g/L. Factors analyzed included sex, age, body mass index (BMI), the American Society of Anesthesiologists (ASA) classification, comorbidities, preoperative platelet count, use of tranexamic acid (TXA), operation time, and type of anesthesia. A total of 3350 patients met the criteria for analysis, with 1782 patients allocated to Group A and 1568 patients to Group B. Five independent risk factors for significant hemorrhage were identified: male sex (odds ratio(OR), 1.29; 95% confidence interval(CI), 1.08–1.53; <i>p</i> = 0.005), age (OR, 1.02; 95% CI, 1.01–1.03; <i>p</i> = 0.001), use of TXA (OR, 0.39; 95% CI, 0.34–0.45; <i>p</i> < 0.001), spinal anesthesia versus general anesthesia (OR, 0.71; 95% CI, 0.56–0.90; <i>p</i> = 0.004), and preoperative platelet count (OR, 0.96; 95% CI, 0.93–0.98; <i>p</i> = 0.001). Of these identified risk factors, preoperative platelet count, use of TXA, and spinal anesthesia are modifiable. These potentially modifiable risk factors need to be taken into consideration when making both the perioperative care and anesthesia plan by surgeons and anesthesiologists, especially in patients at risk of significant hemorrhage.https://www.mdpi.com/2075-4426/12/3/434total knee arthroplastyhemoglobin dropmodifiable risk factorspostoperative hemorrhageanesthesia |
| spellingShingle | En-Bo Wu Kuo-Chuan Hung Sin-Ei Juang Jo-Chi Chin Hsiao-Feng Lu Jih-Yang Ko Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort Study Journal of Personalized Medicine total knee arthroplasty hemoglobin drop modifiable risk factors postoperative hemorrhage anesthesia |
| title | Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort Study |
| title_full | Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort Study |
| title_fullStr | Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort Study |
| title_full_unstemmed | Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort Study |
| title_short | Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort Study |
| title_sort | are risk factors for postoperative significant hemorrhage following total knee arthroplasty potentially modifiable a retrospective cohort study |
| topic | total knee arthroplasty hemoglobin drop modifiable risk factors postoperative hemorrhage anesthesia |
| url | https://www.mdpi.com/2075-4426/12/3/434 |
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