Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip arthroplasty in order to guide a blood-saving program. Method: Retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion data, anesthetic and intraoperative data. The primary outcome was intraoperative or postoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 276 patients included, 179 benefited from Total Hip Prosthesis (THP) and 97 from Intermediate Hip Prosthesis (IHP). Spinal anesthesia was performed in 67.4% of patients. The ASA 2 score predominated (65.9%). The transfusion incidence was 56.9% (157/276). Tranexamic acid was used in 16.3% (45/276) of patients. The average bleeding was 528 ± 405 ml. Preoperative anemia (OR = 0.78, 95% CI [0.66 - 0.91]) and total hip prosthesis (OR = 2.02 95% CI [1.11 - 3.67]) were predictors of bleeding and transfusion to be significant. The average serum hemoglobin predictive of a transfusion was 11.6 ± 1.8. ASA score and operative time were not found as risk factors for bleeding and transfusion. Conclusion: The incidence of transfusion is high. Preoperative anemia remains a major but modifiable risk factor unlike the choice of implant. The implementation of a patient blood management protocol could reduce this transfusion incidence.
References
[1]
Taylor, R.W., et al. (2002) Impact of Allogenic Packed Red Blood Cell Transfusion on Nosocomial Infection Rates in the Critically Ill Patient. Critical Care Medicine, 30, 2249-2254. https://doi.org/10.1097/00003246-200210000-00012
[2]
Spahn, D.R. (2010) Anemia and Patient Blood Management in Hip and Knee Surgery: A Systematic Review of the Literature. Anesthesiology, 113, 482-495. https://doi.org/10.1097/ALN.0b013e3181e08e97
[3]
Jans, Ø., Jørgensen, C., Kehlet, H. and Johansson, P.I. (2014) Role of Preoperative Anemia for Risk of Transfusion and Postoperative Morbidity in Fast-Track Hip and Knee Arthroplasty. Transfusion, 54, 717-726. https://doi.org/10.1111/trf.12332
[4]
Song, K., Pan, P., Yao, Y., Jiang, T. and Jiang, Q. (2019) The Incidence and Risk Factors for Allogenic Blood Transfusion in Total Knee and Hip Arthroplasty. Journal of Orthopaedic Surgery and Research, 14, 273. https://doi.org/10.1186/s13018-019-1329-0
[5]
Menendez, M.E., et al. (2016) Variation in Use of Blood Transfusion in Primary Total Hip and Knee Arthroplasties. The Journal of Arthroplasty, 31, 2757-2763. https://doi.org/10.1016/j.arth.2016.05.022
[6]
Carling, M.S., Jeppsson, A., Eriksson, B.I. and Brisby, H. (2015) Transfusions and Blood Loss in Total Hip and Knee Arthroplasty: A Prospective Observational Study. Journal of Orthopaedic Surgery and Research, 10, 48. https://doi.org/10.1186/s13018-015-0188-6
[7]
Fowler, A.J., et al. (2015) Meta-Analysis of the Association between Preoperative Anaemia and Mortality after Surgery. British Journal of Surgery, 102, 1314-1324. https://doi.org/10.1002/bjs.9861
[8]
Muñoz, M., et al. (2017) Pre-Operative Haemoglobin Levels and Iron Status in a Large Multicentre Cohort of Patients Undergoing Major Elective Surgery. Anaesthesia, 72, 826-834. https://doi.org/10.1111/anae.13840
[9]
Noticewala, M.S., Nyce, J.D., Wang, W., Geller, J.A. and Macaulay, W. (2012) Predicting Need for Allogeneic Transfusion after Total Knee Arthroplasty. The Journal of Arthroplasty, 27, 961-967. https://doi.org/10.1016/j.arth.2011.10.008
[10]
Guerin, S., Collins, C., Kapoor, H., McClean, I. and Collins, D. (2007) Blood Transfusion Requirement Prediction in Patients Undergoing Primary Total Hip and Knee Arthroplasty. Transfusion Medicine, 17, 37-43. https://doi.org/10.1111/j.1365-3148.2006.00698.x
[11]
Ogbemudia, A.E., Yee, S.Y., MacPherson, G.J., Manson, L.M. and Breusch, S.J. (2013) Preoperative Predictors for Allogenic Blood Transfusion in Hip and Knee Arthroplasty for Rheumatoid Arthritis. Archives of Orthopaedic and Trauma Surgery, 133, 1315-1320. https://doi.org/10.1007/s00402-013-1784-8
[12]
Ryan, S.P., et al. (2019) Preoperative Hemoglobin Predicts Postoperative Transfusion Despite Antifbrinolytics during Total Knee Arthroplasty. Orthopedics, 42, 103-109. https://doi.org/10.3928/01477447-20190225-05
[13]
Keating, J.F., Grant, A., Masson, M., et al. (2006) Randomized Comparison of Reduction and Fixation, Bipolar Hemiarthroplasty, and Total Hip Arthroplasty. Treatment of Displaced Intracapsular Hip Fractures in Healthy Older Patients. The Journal of Bone and Joint Surgery. American Volume, 88, 249-260. https://doi.org/10.2106/JBJS.E.00215
[14]
Voskuijl, T., Neuhaus, V., Kinaci, A., et al. (2014) In-Hospital Outcomes after Hemiarthroplasty versus Total Hip Arthroplasty for Isolated Femoral Neck Fractures. Journal of Bone and Joint Surgery, 2, 151-156.
[15]
Liodakis, E., Antoniou, J., Zukor, D.J., et al. (2016) Major Complications and Transfusion Rates after Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures. The Journal of Arthroplasty, 31, 2008-2012. https://doi.org/10.1016/j.arth.2016.02.019
[16]
Zhang, H., Chen, J., Chen, F. and Que, W. (2012) Effect of Tranexamic Acid on Blood Loss and Use of Blood Products in Total Knee Arthroplasty: A Meta-Analysis. Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA), 20, 1742-1752. https://doi.org/10.1007/s00167-011-1754-z
[17]
Gandhi, R., Evans, H.M.K., Mahomed, S.R. and Mahomed, N.N. (2013) Tranexamic Acid and the Reduction of Blood Loss in Total Knee and Hip Arthroplasty: A Meta-Analysis. BMC Research Notes, 6, 184. https://doi.org/10.1186/1756-0500-6-184
[18]
Martin, R., Clayson, P.E., Troussel, S., Fraser, B.P. and Docquier, P.-L. (2011) Anterolateral Minimally Invasive Total Hip Arthroplasty: A Prospective Randomized Controlled Study with a Follow-Up of 1 Year. The Journal of Arthroplasty, 26, 1362-1372. https://doi.org/10.1016/j.arth.2010.11.016
[19]
Speranza, A., Iorio, R., Ferretti, M., D’Arrigo, C. and Ferretti, A. (2007) A Lateral Minimal-Incision Technique in Total Hip Replacement: A Prospective, Randomizes, Controlled Trial. HIP International, 17, 4-8. https://doi.org/10.5301/HIP.2008.492
[20]
Rajagopalan, S., Mascha, E., Na, J. and Sessler, D.I. (2008) The Effects of Mild Perioperative Hypothermia on Blood Loss and Transfusion Requirement. Anesthesiology, 108, 71-77. https://doi.org/10.1097/01.anes.0000296719.73450.52
[21]
Muñoz, M., Gómez-Ramírez, S. and Auerbach, M. (2016) Stimulating Erythropoiesis before Hip Fracture Repair for Reducing Blood Transfusion: Should We Change the Hemoglobin Cut of Level for Defining Anemia in Females? Transfusion, 56, 2160-2163. https://doi.org/10.1111/trf.13750
[22]
Friedman, R., Homering, M., Holberg, G. and Berkowitz, S.D. (2014) Allogeneic Blood Transfusions and Postoperative Infections after Total Hip or Knee Arthroplasty. The Journal of Bone and Joint Surgery. American Volume, 96, 272-278. https://doi.org/10.2106/JBJS.L.01268
[23]
Roque-Castellano, C., et al. (2016) Perioperative Blood Transfusion Is Associated with an Increased Mortality in Older Surgical Patients. World Journal of Surgery, 40, 1795-1801. https://doi.org/10.1007/s00268-016-3521-2
[24]
Owen, A.R., et al. (2022) Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties. The Journal of Bone and Joint Surgery. American Volume, 104, 1542. https://doi.org/10.2106/JBJS.22.00280
[25]
Memtsoudis, S.G., Cozowicz, C., Bekeris, J., et al. (2019) Anaesthetic Care of Patients Undergoing Primary Hip and Knee Arthroplasty: Consensus Recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery Group (ICAROS) Based on a Systematic Review and Meta-Analysis. British Journal of Anaesthesia, 123, 269-287.
[26]
Maniar, R.N., et al. (2019) Role of Suction Drain afer Knee Arthroplasty in the Tranexamic Acid Era: A Randomized Controlled Study. Clinics in Orthopedic Surgery, 11, 73-81. https://doi.org/10.4055/cios.2019.11.1.73
[27]
Sharma, G.M., Palekar, G. and Tanna, D.D. (2016) Use of Closed Suction Drain afer Primary Total Knee Arthroplasty—An Overrated Practice. SICOT-J, 2, 39. https://doi.org/10.1051/sicotj/2016034
[28]
Chen, Z.-Y., Gao, Y., Chen, W., Li, X. and Zhang, Y.-Z. (2014) Is Wound Drainage Necessary in Hip Arthroplasty? A Meta-Analysis of Randomized Controlled Trials. The European Journal of Orthopaedic Surgery and Traumatology, 24, 939-946. https://doi.org/10.1007/s00590-013-1284-0
[29]
DeMaeyera, E. and Adiels-Tegmanb, M. (1985) La prévalence de l’anémie dans le monde. Rapport Trimestriel. Statistique Santé Monde, 38.
[30]
Mathew, K.K., et al. (2020) Is Iron Deficiency Anemia a Risk Factor for Poorer Outcomes in Primary Total Knee Arthroplasty? The Journal of Arthroplasty, 35, 1252-1256. https://doi.org/10.1016/j.arth.2020.01.021
[31]
Viola, J., Gomez, M.M., Restrepo, C., Maltenfort, M.G. and Parvizi, J. (2015) Preoperative Anemia Increases Postoperative Complications and Mortality Following Total Joint Arthroplasty. The Journal of Arthroplasty, 30, 846-848. https://doi.org/10.1016/j.arth.2014.12.026
[32]
Polanco-Garcia, M., Capielo, A.M., Miret, X., et al. (2018) Effectiveness of a Patient Blood Management Protocol on Reduction of Allogeneic Red Blood Cell Transfusions in Orthopedic Surgery. Medicina Clinica, 152, 90-97. https://doi.org/10.1016/j.medcle.2018.12.004
[33]
Kopanidis, P., et al. (2016) Perioperative Blood Management Programme Reduces the Use of Allogenic Blood Transfusion in Patients Undergoing Total Hip and Knee Arthroplasty. Journal of Orthopaedic Surgery and Research, 11, 28. https://doi.org/10.1186/s13018-016-0358-1
[34]
Pinilla-Gracia, C., Mateo-Agudo, J., Herrera, A. and Muñoz, M. (2020) On the Relevance of Preoperative Haemoglobin Optimisation within a Patient Blood Management Programme for Elective Hip Arthroplasty Surgery. Blood Transfusion, 18, 182-190.
[35]
Fenelon, C., et al. (2018) Saving Blood and Reducing Costs: Updating Blood Transfusion Practice in Lower Limb Arthroplasty. Irish Medical Journal, 111, 730.
