Identification of the haemoglobin level associated with a lower risk of complications after total hip and knee arthroplasty

Background Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut‐off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established. Methods Planned secondary analysis of data collec...

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Published in:	Acta anaesthesiologica Scandinavica Vol. 67; no. 5; pp. 629 - 639
Main Authors:	Abad‐Motos, Ane, Ripollés‐Melchor, Javier, Jericó, Carlos, Bisbe, Elvira, Basora, Misericordia, Colomina, Maria J., Becerra‐Bolaños, Ángel, Bermúdez‐López, María, Massa‐Gómez, Cristina, Albaladejo‐Magdalena, Javier, Solar‐Herrera, Ana, Pérez‐Chrzanowska, Hanna, Yárnoz, Carlos, Fedriani‐de‐Matos, Jacobo José, Blanco‐Del‐Val, Beatriz, Fabián‐González, David, Bellver, Jorge, Redondo‐Enríquez, Juan M., Serrat‐Puyol, Jordi, Abad‐Gurumeta, Alfredo, Zorrilla‐Vaca, Andrés, Aldecoa, César, García‐Erce, José Antonio
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-05-2023
Subjects:	anaemia Anemia Anemia - complications Anemia - epidemiology Arthroplasty (knee) Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Knee - adverse effects Biomedical materials Blood Transfusion Cohort Studies Complications Erythrocytes Female Hemoglobin Hemoglobins Hip Humans Joint replacement surgery Knee Length of Stay Male Morbidity Orthopaedic implants orthopaedic surgery outcomes patient blood management Patients Postoperative postoperative complications Postoperative Complications - epidemiology Postoperative Complications - etiology Regression analysis Secondary analysis Total hip arthroplasty total knee arthroplasty total hip arthroplasty total knee arthroplasty orthopaedic surgery anaemia outcomes postoperative complications patient blood management
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Summary:	Background Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut‐off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established. Methods Planned secondary analysis of data collected during a multicentre cohort study of patients undergoing THA and TKA in 131 Spanish hospitals during a single 2‐month recruitment period. Anaemia was defined as haemoglobin <12 g dl−1 for females and < 13 g dl−1 for males. The primary outcome was the number of patients with 30‐day in‐hospital postoperative complications according to European Perioperative Clinical Outcome definitions and specific surgical TKA and THA complications. Secondary outcomes included the number of patients with 30‐day moderate‐to‐severe complications, red blood cell transfusion, mortality, and length of hospital stay. Binary logistic regression models were constructed to assess association between preoperative Hb concentrations and postoperative complications, and variables significantly associated with the outcome were included in the multivariate model. The study sample was divided into 11 groups based on preoperative Hb values in an effort to identify the threshold at which increased postoperative complications occurred. Results A total of 6099 patients were included in the analysis (3818 THA and 2281 TKA), of whom 8.8% were anaemic. Patients with preoperative anaemia were more likely to suffer overall complications (111/539, 20.6% vs. 563/5560, 10.1%, p < .001) and moderate‐to‐severe complications (67/539, 12.4% vs. 284/5560, 5.1%, p < .001). Multivariable analysis showed preoperative haemoglobin ≥14 g dl−1 was associated with fewer postoperative complications. Conclusion Preoperative haemoglobin ≥14 g dl−1 is associated with a lower risk of postoperative complications in patients undergoing primary TKA and THA.
Bibliography:	Ane Abad‐Motos, Javier Ripollés‐Melchor, César Aldecoa, and José Antonio García‐Erce contributed equally to this study. Members of the POWER2 Study Investigators Group are listed in the Supporting Information. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0001-5172 1399-6576
DOI:	10.1111/aas.14217