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Preoperative haemoglobin cut-off values for the prediction of post-operative transfusion in total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study is to determine preoperative haemoglobin cut-off values that could accurately predict post-operative transfusion outcome in patients undergoing primary unilateral total knee arthroplasty (TKA). This will allow surgeons to provide selective preoperative type and screen to only patients at high risk of transfusion.

Methods

A total of 1457 patients diagnosed with osteoarthritis and underwent primary unilateral TKA between January 2012 and December 2014 were retrospectively reviewed. Logistic regression analyses were applied to identify factors that could predict transfusion outcome.

Results

A total of 37 patients (2.5 %) were transfused postoperatively. Univariate analysis revealed preoperative haemoglobin (p < 0.001), age (p < 0.001), preoperative haematocrit (p < 0.001), and preoperative creatinine (p < 0.001) to be significant predictors. In the multivariate analysis with patients dichotomised at 70 years of age, preoperative haemoglobin remained significant with adjusted odds ratio of 0.33. Receiver operating characteristic curve identified the preoperative haemoglobin cut-off values to be 12.4 g/dL (AUC = 0.86, sensitivity = 87.5 %, specificity = 77.2 %) and 12.1 g/dL (AUC = 0.85, sensitivity = 69.2 %, specificity = 87.1 %) for age above and below 70, respectively.

Conclusions

The authors recommend preoperative haemoglobin cut-off values of 12.4 g/dL for age above 70 and 12.1 g/dL for age below 70 to be used to predict post-operative transfusion requirements in TKA. To maximise the utilisation of blood resources, the authors recommend that only patients with haemoglobin level below the cut-off should receive routine preoperative type and screen before TKA.

Level of evidence

IV.

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References

  1. Ahmed I, Chan JK, Jenkins P, Brenkel I, Walmsley P (2012) Estimating the transfusion risk following total knee arthroplasty. Orthopedics 35(10):e1465–e1471

    Article  PubMed  Google Scholar 

  2. Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM (2011) Tranexamic acid in total knee replacement: a systemic review and meta-analysis. J Bone Joint Surg Br 93(12):1577–1585

    Article  CAS  PubMed  Google Scholar 

  3. Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM (2014) A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J 96(B(8)):1005–1015

    Article  PubMed  Google Scholar 

  4. Basora M, Tio M, Martin N et al (2014) Should all patients be optimized to the same preoperative hemoglobin level to avoid transfusion in primary knee arthroplasty? Vox Sang 107(2):148–152

    Article  CAS  PubMed  Google Scholar 

  5. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 81(1):2–10

    CAS  PubMed  Google Scholar 

  6. Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE (2004) Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty 19(3):281–287

    Article  PubMed  Google Scholar 

  7. Chen JY, Chin PL, Moo IH et al (2016) Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: a double-blinded randomised controlled noninferiority trial. Knee 23(1):152–156

    Article  PubMed  Google Scholar 

  8. Chen JY, Lo NN, Tay DK, Chin PL, Chia SL, Yeo SJ (2015) Intra-articular administration of tranexamic acid in total hip arthroplasty. J Orthop Surg (Hong Kong) 23(2):213–217

    Google Scholar 

  9. Frisch NB, Wessell NM, Charters MA, Yu S, Jeffries JJ, Silverton CD (2014) Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplasty 29(9 Suppl):189–192

    Article  PubMed  Google Scholar 

  10. Fujimoto H, Ozaki T, Asaumi K et al (2003) Blood loss in patients for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 11(3):149–154

    PubMed  Google Scholar 

  11. Gomez-Barrena E, Ortega-Andreu M, Padilla-Eguiluz NG, Perez-Chrzanowska H, Figueredo-Zalve R (2014) Topical intra-articular compared with intravenous tranexamic acid to reduce blood loss in primary total knee replacement: a double-blind, randomized, controlled, noninferiority clinical trial. J Bone Joint Surg Am 96(23):1937–1944

    Article  PubMed  Google Scholar 

  12. Gonzalez-Porras JR, Colado E, Conde MP, Lopez T, Nieto MJ, Corral M (2009) An individualized pre-operative blood saving protocol can increase pre-operative haemoglobin levels and reduce the need for transfusion in elective total hip or knee arthroplasty. Transfus Med 19(1):35–42

    Article  CAS  PubMed  Google Scholar 

  13. Goodnough LT, Shander A, Spivak JL et al (2005) Detection, evaluation, and management of anemia in the elective surgical patient. Anesth Analg 101(6):1858–1861

    Article  PubMed  Google Scholar 

  14. Goyal N, Kaul R, Harris IA, Chen DB, MacDessi SJ (2016) Is there a need for routine post-operative hemoglobin level estimation in total knee arthroplasty with tranexamic acid use? Knee 23(2):310–313

    Article  PubMed  Google Scholar 

  15. Guerin S, Collins C, Kapoor H, McClean I, Collins D (2007) Blood transfusion requirement prediction in patients undergoing primary total hip and knee arthroplasty. Transfus Med 17(1):37–43

    CAS  PubMed  Google Scholar 

  16. Hart A, Khalil JA, Carli A, Huk O, Zukor D, Antoniou J (2014) Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am 96(23):1945–1951

    Article  PubMed  Google Scholar 

  17. Jans O, Jorgensen C, Kehlet H, Johansson PI (2014) Role of preoperative anemia for risk of transfusion and post-operative morbidity in fast-track hip and knee arthroplasty. Transfusion 54(3):717–726

    Article  PubMed  Google Scholar 

  18. Keating EM, Meding JB, Faris PM, Ritter MA (1998) Predictors of transfusion risk in elective knee surgery. Clin Orthop Relat Res 357:50–59

    Article  PubMed  Google Scholar 

  19. Larocque BJ, Gilbert K, Brien WF (1997) A point score system for predicting the likelihood of blood transfusion after hip or knee arthroplasty. Transfusion 37(5):463–467

    Article  CAS  PubMed  Google Scholar 

  20. Larocque BJ, Gilbert K, Brien WF (1998) Prospective validation of a point score system for predicting blood transfusion following hip or knee replacement. Transfusion 38(10):932–937

    Article  CAS  PubMed  Google Scholar 

  21. Marson BA, Shah J, Deglurkar M (2015) Blood transfusion in hip and knee arthroplasties: the end of the pre-operative group and save? Eur J Orthop Surg Traumatol 25(5):871–875

    Article  CAS  PubMed  Google Scholar 

  22. Noticewala MS, Nyce JD, Wang W, Geller JA, Macaulay W (2012) Predicting need for allogeneic transfusion after total knee arthroplasty. J Arthroplasty 27(6):961–967

    Article  PubMed  Google Scholar 

  23. Park JH, Rasouli MR, Mortazavi SM, Tokarski AT, Maltenfort MG, Parvizi J (2013) Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am 95(19):1777–1783

    Article  PubMed  Google Scholar 

  24. Salido JA, Marin LA, Gomez LA, Zorrilla P, Martinez C (2002) Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. J Bone Joint Surg Am 84(A(2)):216–220

    PubMed  Google Scholar 

  25. Schwab PE, Lavand’homme P, Yombi J, Thienpont E (2015) Aspirin mono-therapy continuation does not result in more bleeding after knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3824-0

    Google Scholar 

  26. Schwab PE, Thienpont E (2015) Use of a haemostatic matrix does not reduce blood loss in minimally invasive total knee arthroplasty. Blood Transfus 13(3):435–441

    PubMed  PubMed Central  Google Scholar 

  27. Schwab PE, Thienpont E (2016) Use of a haemostatic matrix (Floseal®) does not reduce blood loss in minimally invasive total knee arthroplasty performed under continued aspirin. Blood Transfus 14(2):134–139

    PubMed  PubMed Central  Google Scholar 

  28. Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 7(3):151–155

    Article  PubMed  Google Scholar 

  29. Sehat KR, Evans RL, Newman JH (2004) Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br 86(4):561–565

    CAS  PubMed  Google Scholar 

  30. Tan J, Chen H, Liu Q, Chen C, Huang W (2013) A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. J Surg Res 184(2):880–887

    Article  CAS  PubMed  Google Scholar 

  31. van Klei WA, Moons KG, Leyssius AT, Knape JT, Rutten CL, Grobbee DE (2001) A reduction in type and screen: preoperative prediction of RBC transfusions in surgery procedures with intermediate transfusion risks. Br J Anaesth 87(2):250–257

    Article  PubMed  Google Scholar 

  32. van Klei WA, Moons KG, Rheineck-Leyssius AT et al (2002) Validation of a clinical prediction rule to reduce preoperative type and screen procedures. Br J Anaesth 89(2):221–225

    Article  PubMed  Google Scholar 

  33. Yang ZG, Chen WP, Wu LD (2012) Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 94(13):1153–1159

    Article  PubMed  Google Scholar 

  34. Yoshihara H, Yoneoka D (2014) Predictors of allogeneic blood transfusion in total hip and knee arthroplasty in the United States, 2000-2009. J Arthroplasty 29(9):1736–1740

    Article  PubMed  Google Scholar 

  35. Zhu M, Chen JY, Tan YR et al (2015) Effects of anesthetic technique on blood loss and complications after simultaneous bilateral total knee arthroplasty. Arch Orthop Trauma Surg 135(4):565–571

    Article  PubMed  Google Scholar 

  36. Zhu M, Chen JY, Yew AK, Chia SL, Lo NN, Yeo SJ (2015) Intra-articular tranexamic acid wash during bilateral total knee arthroplasty. J Orthop Surg (Hong Kong) 23(3):290–293

    Google Scholar 

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Acknowledgments

This study was supported by the SingHealth Foundation Grant (SHF/FG553P/2014); funding was provided for collection of the data.

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Correspondence to Jared Ze Yang Yeh.

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Yeh, J.Z.Y., Chen, J.Y., Bin Abd Razak, H.R. et al. Preoperative haemoglobin cut-off values for the prediction of post-operative transfusion in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24, 3293–3298 (2016). https://doi.org/10.1007/s00167-016-4183-1

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  • DOI: https://doi.org/10.1007/s00167-016-4183-1

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