What Should Define Preoperative Anemia in Primary THA?

• DOI: 10.1007/s11999-017-5469-4
• Publication Date: 2017-08-07T14:36:00Z
• Authors: Mitchell R. Klement; Ashwin Peres-Da-S...; Brian T. Nickel; Cynthia L. Green; Samuel S. Wellman; David E. Attarian; Michael P. Bolognesi; Thorsten M. Seyler
• Keywords: Male; Chi-Square Distribution; Time Factors; Knee Joint; Blood Loss, Surgical; Anemia; Postoperative Hemorrhage; Antifibrinolytic Agents; 3. Good health; Hemoglobins; Logistic Models; Predictive Value of Tests; Risk Factors; Multivariate Analysis; Odds Ratio; Humans; Blood Transfusion; Female; Arthroplasty, Replacement, Knee; Biomarkers; Retrospective Studies

The use of tranexamic acid (TXA) in THA decreases the risk transfusion after surgery. However, nearly 10% patients still undergo a transfusion, which has been independently associated with an increased complications. Preoperative anemia proven to be strong predictor THA, but ideal "cutoff" values today's population that maximize sensitivity and specificity predict have yet established.(1) Which preoperative factors are postoperative setting TXA use? (2) If hemoglobin (Hgb) remains what best-supported Hgb cutoff THA?A retrospective chart analysis was performed from January 1, 2013, 2015, on 558 primary THAs met prespecified inclusion criteria. A multivariable logistic regression model used identify independent transfusion. Area under receiver-operator curve (AUC) determine cut point across all participants, as well adjusted by sex use. Overall, 60 blood were included compared 498 control subjects (11% transfusion).After controlling for potential confounding variables such age, sex, American Society Anesthesiologist score, intravenous (IV TXA) use, Hgb, we found lower (g/dL per 1-unit decrease, odds ratio [OR], 2.6; 95% CI, 2.0-3.5; p < 0.001), female (vs male, OR, 4.2; 1.7-10.3; = 0.002), those unable receive IV (topical TXA/no TXA, 13.5; 6.3-28.6; 0.001) more likely Of these, variable most highly (AUC, 0.876). value 12.6 g/dL maximized AUC (0.876) predicting unadjusted baseline characteristics (sensitivity 83, 84) 12.5 85, 77) 13.5 92, women men, respectively.The 1968 WHO definitions (preoperative 13 men 12 women) currently may underestimate at today. Further studies needed see if conservation referral treatment anemia.Level III, therapeutic study.