Preoperative Anaemia in Primary Hip and Knee Arthroplasty

Patrick Meybohm; Hendrik Kohlhof; Dieter Christian Wirtz; Ingo Marzi; Christoph Füllenbach; Suma Choorapoikayil; Maria Wittmann; Ursula Marschall; Josef Thoma; Klaus Schwendner; Patrick Stark; Ansgar Raadts; Jens Friedrich; Henry Weigt; Patrick Friederich; Josef Huber; Martin Gutjahr; Elke Schmitt; Kai Zacharowski

doi:10.1055/a-0974-4115

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2020; 158(02): 194-200
DOI: 10.1055/a-0974-4115

Original Article/Originalarbeit

Georg Thieme Verlag KG Stuttgart · New York

Preoperative Anaemia in Primary Hip and Knee Arthroplasty

Article in several languages: English | deutsch

Patrick Meybohm^*

¹Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt

,

Hendrik Kohlhof^*

²Department of Orthopedics and Trauma Surgery, University Hospital Bonn

,

Dieter Christian Wirtz

²Department of Orthopedics and Trauma Surgery, University Hospital Bonn

,

Ingo Marzi

³Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt am Main

,

Christoph Füllenbach

¹Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt

,

Suma Choorapoikayil

¹Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt

,

Maria Wittmann

⁴Department of Anesthesiology and Operative Intensive Care Medicine, University Hospital Bonn

,

Ursula Marschall

⁵Head of Department Medicine/Health Care Research, Barmer, Wuppertal

,

Josef Thoma

⁶Department of Anesthesiology and Operative Intensive Medicine, ORTENAU KLINIKUM Offenburg-Kehl, Offenburg

,

Klaus Schwendner

⁷Department of Anesthesiology and Operative Intensive Care Medicine, Martha-Maria Hospital Nuremberg

,

Patrick Stark

⁸Department of Visceral and Vascular Surgery, Klinikum Mittelmosel, Zell

,

Ansgar Raadts

⁹Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena

,

Jens Friedrich

¹⁰Department of Anesthesiology and Operative Intensive Care Medicine, Klinikum Leverkusen gGmbH

,

Henry Weigt

¹¹Department of Anesthesiology, SLK-Kliniken Heilbronn GmbH

,

Patrick Friederich

¹²Department of Anesthesiology, Operative Intensive Medicine and Pain Therapy, München Klinik Bogenhausen

,

Josef Huber

¹³Institute for Laboratory Diagnostics and Transfusion Medicine, Donauisar Klinikum Deggendorf

,

Martin Gutjahr

¹⁴Department for Anesthesiology, Intensive Medicine and Pain Therapy, Marienhausklinik Ottweiler

,

Elke Schmitt^**

¹Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt

¹⁵Institute for Biostatistics and Mathematical Modelling, Goethe University Frankfurt

,

Kai Zacharowski^**

¹Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt

› Author Affiliations

Abstract

Introduction Approximately one in three patients has untreated preoperative anaemia, which in turn is associated with an increased need for transfusion of allogenic red blood cell concentrates (RBC) and complications in the context of a surgical intervention. Here, the prevalence of preoperative and postoperative anaemia as well as their effects on transfusion rate, hospital length of stay and hospital mortality in primary hip and knee arthroplasty has been analysed.

Methods From January 2012 to September 2018, 378,069 adult inpatients from 13 German hospitals were analysed on the basis of an anonymized registry. Of these, n = 10,017 patients had a hip and knee joint primary arthroplasty. The primary endpoint was the incidence of preoperative anaemia, which was analysed by the first available preoperative haemoglobin value according to the WHO definition. Secondary endpoints included in-hospital length of stay, number of patients with red blood cell concentrate transfusion, incidence of hospital-acquired anaemia, number of deceased patients, and postoperative complications.

Results The preoperative anaemia rate was 14.8% for elective knee joint arthroplasty, 22.9% for elective hip joint arthroplasty and 45.0% for duo-prosthesis implantation. Preoperative anaemia led to a significantly higher transfusion rate (knee: 8.3 vs. 1.8%; hip: 34.5 vs. 8.1%; duo-prosthesis: 42.3 vs. 17.4%), an increased red blood cell concentrate consumption (knee: 256 ± 107 vs. 29 ± 5 RBC/1000 patients; hip: 929 ± 60 vs. 190 ± 16 RBC/1000 patients; duo-prosthesis: 1411 ± 98 vs. 453 ± 42 RBC/1000 patients). Pre-operative anaemia was associated with prolonged hospital stay (12.0 [10.0; 17.0] d vs. 11.0 [9.0; 13.0] d; p < 0.001) and increased mortality (5.5% [4.6 – 6.5%] vs. 0.9% [0.7 – 1.2%]; Fisher p < 0.001) compared to non-anaemic patients. In patients aged 80 years and older, the incidence of preoperative anaemia and thus the transfusion rate was almost twice as high as in patients under 80 years of age.

Summary Preoperative anaemia is common in knee and hip primary arthroplasty and was associated with a relevant increase in red blood cell concentrate consumption. In the context of patient blood management, a relevant potential arises, especially in elective orthopaedic surgery, to better prepare elective patients, to avoid unnecessary transfusions and thus to conserve the valuable resource blood.

Key words

anaemia - blood loss - blood transfusion - orthopaedic surgery

Full Text

References

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