Effects of preoperative anemia on postoperative outcome of unilateral total hip arthroplasty_West China Medical Journal

Authors：

DUAN Shanshan , ZHAO Ruying , ZHOU Ting , WANG Liqun , LI Peifang , HOU Xiaoling ,  NING Ning

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

NING Ning, Email: gkningning@126.com

Keywords：

Anemia; Total hip arthroplasty; Enhanced recovery after surgery

DOI：

10.7507/1002-0179.201907176

Video：

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Objective To explore the postoperative effect of preoperative anemia on patients undergoing unilateral total hip arthroplasty (THA).Methods A total of 200 patients undergoing unilateral primary THA from July to September 2018 were selected. According to the preoperative hemoglobin level and the World Health Organization definition of anemia (hemoglobin below 120 g/L for women and below 130 g/L for men), the patients were divided into the non-anemia group and the anemia group. All anemia patients were given dietary guidance and balanced diet before the operation, and no drug treatment was given. Both groups adopted accelerated rehabilitation strategy during the perioperative period, and postoperative anemia was treated according to a unified standard. The intraoperative blood loss and length of operation of the two groups were recorded. The presence of anemia on the first postoperative day, postoperative blood transfusion rate, incidence of postoperative complications (hypotension, nausea and vomiting on the first postoperative day, and infection-related unplanned readmission within 90 days after discharge), range of motion of the hip joint (hip flexion and hip abduction), and length of hospital stay were compared between the two groups.Results In the 200 patients, 51 (25.50%) presented anemia before surgery and 149 did not. There were 114 cases developing mild anemia and 7 cases developing moderate anemia after surgery in the non-anemia group, with an anemia incidence of 81.21%; in the anemia group, there were 30 cases of mild anemia and 20 cases of moderate anemia, and 1 case did not have anemia after surgery. The postoperative transfusion rates of the non-anemia group and the anemia group were 2.01% and 11.76%, respectively, and the incidences of postoperative complications were 7.38% and 35.29%, respectively; the differences were statistically significant (P<0.05). However, there was no statistically significant difference in hip mobility or length of hospital stay between the two groups (P>0.05).Conclusions Quite a few patients undergoing THA have anemia before surgery. The incidence of postoperative anemia is high due to the trauma and massive bleeding of the operation, and preoperative anemia will aggravate anemia after surgery. Preoperative anemia can increase the perioperative transfusion rate of THA patients, increase the incidence of postoperative complications, and affect the hospitalization experience of patients.

Citation： DUAN Shanshan, ZHAO Ruying, ZHOU Ting, WANG Liqun, LI Peifang, HOU Xiaoling, NING Ning. Effects of preoperative anemia on postoperative outcome of unilateral total hip arthroplasty. West China Medical Journal, 2019, 34(9): 1005-1009. doi: 10.7507/1002-0179.201907176 Copy

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2.	Spahn DR. Anemia and patient blood management in hip andknee surgery: a systematic review of the literature. Anesthesiology, 2010, 113(2): 482-495.
3.	Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee, 2000, 7(3): 151-155.
4.	Hill GE, Frawley WH, Griffith KE, et al. Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis. J Trauma, 2003, 54(5): 908-914.
5.	Raghavan M, Marik PE. Anemia, allogenic blood transfusion, and immunomodulation in the critically ill. Chest, 2005, 127(1): 295-307.
6.	Wilson WJ. Intraoperative autologous transfusion in revision total hip arthroplasty. J Bone Joint Surg Am, 1989, 71(1): 8-14.
7.	Beattie WS, Karkouti K, Wijeysundera DN. Risk associated with preoperative anemia in noncardiac surgery a single-center cohort study. Anesthesiology, 2009, 110(3): 574-581.
8.	Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet, 2011, 378(980): 1396-1407.
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13.	曹國瑞, 張少云, 黃強, 等. 術后口服氨甲環酸在全髖關節置換術中的安全性和有效性研究. 中國矯形外科雜志, 2018, 26(1): 27-32.
14.	周宗科, 翁習生, 向兵, 等. 中國髖、膝關節置換術加速康復——圍術期貧血診治專家共識. 中華骨與關節外科雜志, 2016, 9(1): 10-15.
15.	Gwynne-Jones DP, Martin G, Crane C. Enhanced recovery after surgery for hip and knee replacements. Orthop Nurs, 2017, 6(3): 203-210.
16.	趙建寧, 包倪榮. 人工關節置換術后并發癥的防治與功能鍛煉. 中國骨傷, 2011, 24(6): 445-447.
17.	楊紅, 李希斌, 譚潔, 等. 單側全髖關節置換術圍手術期總失血量的相關影響因素分析. 中國骨傷, 2017, 30(11): 1008-1012.
18.	黃貴林, 趙玉陽, 勾寶晶. 術前血容量對骨科手術中血流動力學變化及術后惡心嘔吐的影響. 中國藥物經濟學, 2014, 9(增刊1): 231-232.
19.	王偉, 劉軍, 周勝虎, 等. 人工關節置換術后假體周圍感染與術前貧血的研究進展. 中國骨傷, 2018, 31(10): 971-975.
20.	Kü?ükdurmaz F, Parvizi J. The prevention of periprosthetic joint infections. Open Orthop J, 2016, 10(11): 589.
21.	王華鋒, 劉恒旸, 王靜成. 骨科大手術圍手術期貧血狀況及血液管理. 中華創傷骨科雜志, 2012, 14(6): 532-535.
22.	袁磊, 包倪榮, 趙建寧. 髖關節置換術后隱性失血的新進展. 中國骨傷, 2015, 28(4): 378-382.

1. Evans S, O’Loughlin E, Bruce J. Retrospective audit of blood transfusion and comparison with haemoglobin concentration in patients undergoing elective primary and revision lower limb arthroplasty. Anaesth Intensive Care, 2011, 39(3): 480-485.
2. Spahn DR. Anemia and patient blood management in hip andknee surgery: a systematic review of the literature. Anesthesiology, 2010, 113(2): 482-495.
3. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee, 2000, 7(3): 151-155.
4. Hill GE, Frawley WH, Griffith KE, et al. Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis. J Trauma, 2003, 54(5): 908-914.
5. Raghavan M, Marik PE. Anemia, allogenic blood transfusion, and immunomodulation in the critically ill. Chest, 2005, 127(1): 295-307.
6. Wilson WJ. Intraoperative autologous transfusion in revision total hip arthroplasty. J Bone Joint Surg Am, 1989, 71(1): 8-14.
7. Beattie WS, Karkouti K, Wijeysundera DN. Risk associated with preoperative anemia in noncardiac surgery a single-center cohort study. Anesthesiology, 2009, 110(3): 574-581.
8. Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet, 2011, 378(980): 1396-1407.
9. 龐清江, 王誠浩. 關節置換術圍術期血液管理研究進展. 現代實用醫學, 2018, 30(6): 701-704.
10. World Health Organization. Iron deficiency anaemia assessment, prevention and control: a guide for programme managers. Geneva: World Health Organization, 2001.
11. 尤黎明, 吳瑛. 內科護理學. 4版. 北京: 人民衛生出版社, 2006: 312.
12. 周宗科, 翁習生, 曲鐵兵, 等. 中國髖、膝關節置換術加速康復——圍術期管理策略專家共識. 中華骨與關節外科雜志, 2016, 9(1): 1-9.
13. 曹國瑞, 張少云, 黃強, 等. 術后口服氨甲環酸在全髖關節置換術中的安全性和有效性研究. 中國矯形外科雜志, 2018, 26(1): 27-32.
14. 周宗科, 翁習生, 向兵, 等. 中國髖、膝關節置換術加速康復——圍術期貧血診治專家共識. 中華骨與關節外科雜志, 2016, 9(1): 10-15.
15. Gwynne-Jones DP, Martin G, Crane C. Enhanced recovery after surgery for hip and knee replacements. Orthop Nurs, 2017, 6(3): 203-210.
16. 趙建寧, 包倪榮. 人工關節置換術后并發癥的防治與功能鍛煉. 中國骨傷, 2011, 24(6): 445-447.
17. 楊紅, 李希斌, 譚潔, 等. 單側全髖關節置換術圍手術期總失血量的相關影響因素分析. 中國骨傷, 2017, 30(11): 1008-1012.
18. 黃貴林, 趙玉陽, 勾寶晶. 術前血容量對骨科手術中血流動力學變化及術后惡心嘔吐的影響. 中國藥物經濟學, 2014, 9(增刊1): 231-232.
19. 王偉, 劉軍, 周勝虎, 等. 人工關節置換術后假體周圍感染與術前貧血的研究進展. 中國骨傷, 2018, 31(10): 971-975.
20. Kü?ükdurmaz F, Parvizi J. The prevention of periprosthetic joint infections. Open Orthop J, 2016, 10(11): 589.
21. 王華鋒, 劉恒旸, 王靜成. 骨科大手術圍手術期貧血狀況及血液管理. 中華創傷骨科雜志, 2012, 14(6): 532-535.
22. 袁磊, 包倪榮, 趙建寧. 髖關節置換術后隱性失血的新進展. 中國骨傷, 2015, 28(4): 378-382.

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