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Preoperative Anemia in Total Joint Arthroplasty: Is It Associated with Periprosthetic Joint Infection?

  • Symposium: 2011 Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Anemia is common in patients undergoing total joint arthroplasty (TJA). Numerous studies have associated anemia with increased risk of infection, length of hospital stay, and mortality in surgical populations. However, it is unclear whether and to what degree preoperative anemia in patients undergoing TJA influences postoperative periprosthetic joint infection (PJI) and mortality.

Questions/Purposes

We therefore (1) determined the incidence of preoperative anemia in patients undergoing TJA; (2) assessed the possible association between preoperative anemia and subsequent PJI; and (3) explored the relationship between preoperative anemia with postoperative mortality.

Methods

We identified 15,722 patients who underwent TJA from January 2000 to June 2007. Anemia was defined as hemoglobin < 12 g/dL in women and hemoglobin < 13 g/dL in men. We determined the effect of preoperative anemia, demographics, and comorbidities on postoperative complications.

Results

Of the 15,222 patients, 19.6% presented with preoperative anemia. PJI occurred more frequently in anemic patients at an incidence of 4.3% in anemic patients compared with 2% in nonanemic patients. Thirty-day (0.4%), 90-day (0.6%), and 1-year (1.8%) mortality rates were not higher in patients with preoperative anemia. Forty-four percent of anemic patients received an allogenic transfusion compared with only 13.4% of nonanemic patients. Anemic patients had increased hospital stays averaging 4.3 days compared with 3.9 days in nonanemic patients. Anemia did not predict cardiac complications.

Conclusion

Our data demonstrate that preoperative anemia is associated with development of subsequent PJI. Preoperative anemia was not associated with 30-day, 60-day, or 1-year mortality in this cohort.

Level of Evidence

Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Ronald Huang, BS, for his contribution to data collection and insight into the study design.

Author information

Authors and Affiliations

  1. The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    Max Greenky BA, Luis Pulido MD, Camilo Restrepo MD & Javad Parvizi MD

  2. Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Kishor Gandhi MD, MPH

Authors
  1. Max Greenky BA
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  2. Kishor Gandhi MD, MPH
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  3. Luis Pulido MD
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  4. Camilo Restrepo MD
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  5. Javad Parvizi MD
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Corresponding author

Correspondence to Javad Parvizi MD.

Additional information

One of the authors (JP) has or may receive payments or benefits, in any one year, an amount in excess of $10,000 from Zimmer (Warsaw, IN, USA), Smith & Nephew (Memphis, TN, USA), Convatech, and Biomet (Warsaw, IN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Greenky, M., Gandhi, K., Pulido, L. et al. Preoperative Anemia in Total Joint Arthroplasty: Is It Associated with Periprosthetic Joint Infection?. Clin Orthop Relat Res 470, 2695–2701 (2012). https://doi.org/10.1007/s11999-012-2435-z

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  • DOI: https://doi.org/10.1007/s11999-012-2435-z

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