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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2024

Open Access 01-12-2024 | Anemia | Research article

Impact of preoperative anemia on patients undergoing total joint replacement of lower extremity: a systematic review and meta-analysis

Authors: Fu-Qiang Zhang, Yong-Ze Yang, Peng-Fei Li, Guo-Rong Ma, An-Ren Zhang, Hui Zhang, Hong-Zhang Guo

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

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Abstracts

Purpose

Preoperative anemia increases postoperative morbidity, mortality, and the risk of allogeneic transfusion. However, the incidence of preoperative anemia in patients undergoing total hip arthroplasty and total knee arthroplasty (TKA) and its relationship to postoperative outcomes has not been previously reported.

Methods

We conducted a comprehensive literature search through PubMed, Cochrane Library, Web of Sincien, and Embase from inception to July 2023 to investigate the prevalence of preoperative anemia in patients undergoing Total Joint Arthroplasty, comorbidities between anemic and non-anemicpatients before surgery, and postoperative outcomes. postoperative outcomes were analyzed. Overall prevalence was calculated using a random-effects model, and heterogeneity between studies was examined by Cochran's Q test and quantified by the I2 statistic. Subgroup analyses and meta-regression analyses were performed to identify sources of heterogeneity. Publication bias was assessed by funnel plots and validated by Egger's test.

Results

A total of 21 studies with 369,101 samples were included, all of which were retrospective cohort studies. 3 studies were of high quality and 18 studies were of moderate quality. The results showed that the prevalence of preoperative anemia was 22% in patients awaiting arthroplasty; subgroup analyses revealed that the prevalence of preoperative anemia was highest in patients awaiting revision of total knee arthroplasty; the highest prevalence of preoperative anemia was found in the Americas; preoperative anemia was more prevalent in the female than in the male population; and preoperative anemia with a history of preoperative anemia was more common in the female than in the male population. patients with a history of preoperative anemia; patients with joint replacement who had a history of preoperative anemia had an increased risk of infection, postoperative blood transfusion rate, postoperative blood transfusion, Deep vein thrombosis of the lower limbs, days in hospital, readmission within three months, and mortality compared with patients who did not have preoperative anemia.

Conclusion

The prevalence of preoperative anemia in patients awaiting total joint arthroplasty is 22%, and is higher in TKA and female patients undergoing revision, while preoperative anemia is detrimental to the patient's postoperative recovery and will increase the risk of postoperative complications, transfusion rates, days in the hospital, readmission rates, and mortality.
Appendix
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Literature
1.
Jans Ø, Jørgensen C, Kehlet H, Johansson PI. Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty. Transfusion. 2014;54(3):717–26.PubMedCrossRef
2.
Serrano-Trenas JA, Ugalde PF, Cabello LM, Chofles LC, Lázaro PS, Benítez PC. Role of perioperative intravenous iron therapy in elderly hip fracture patients: a single-center randomized controlled trial. Transfusion. 2011;51(1):97–104.PubMedCrossRef
3.
Litton E, Xiao J, Ho KM. Safety and efficacy of intravenous iron therapy in reducing the requirement for allogeneic blood transfusion: a systematic review and meta-analysis of randomized clinical trials. BMJ. 2013;347: f4822.PubMedPubMedCentralCrossRef
4.
Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology. 2010;113(2):482–95.PubMedCrossRef
5.
Beattie WS, Karkouti K, Wijeysundera DN, Tait G. Risk associated with preoperative anemia in noncardiac surgery: a single-center cohort study. Anesthesiology. 2009;110(3):574–81.PubMedCrossRef
6.
Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003;43(4):459–69.PubMedCrossRef
7.
Abdullah HR, Sim YE, Hao Y, Lin GY, Liew GHC, Lamoureux EL, et al. Association between preoperative anemiaanemia with a length of hospital stay among patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study. BMJ Open. 2017;7(6): e016403.PubMedPubMedCentralCrossRef
8.
Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop. 2008;79(2):168–73.PubMedCrossRef
9.
Boralessa H, Goldhill DR, Tucker K, Mortimer AJ, Grant-Casey J. National comparative audit of blood use in elective primary unilateral total hip replacement surgery in the UK. Ann R Coll Surg Engl. 2009;91(7):599–605.PubMedPubMedCentralCrossRef
10.
Williamson LM, Lowe S, Love EM, Cohen H, Soldan K, McClelland DB, et al. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. BMJ. 1999;319(7201):16–9.PubMedPubMedCentralCrossRef
11.
Hill GE, Frawley WH, Griffith KE, Forestner JE, Minei JP. Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis. J Trauma. 2003;54(5):908–14.PubMedCrossRef
12.
Weber EWG, Slappendel R, Prins MH, van der Schaaf DB, Durieux ME, Strümper D. Perioperative blood transfusions and delayed wound healing after hip replacement surgery: effects on duration of hospitalization. Anesth Analg. 2005;100(5):1416–21.PubMedCrossRef
13.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg Am. 2007;89(4):780–5.CrossRef
14.
Lu M, Sing DC, Kuo AC, Hansen EN. Preoperative anemia independently predicts 30-day complications after aseptic and septic revision total joint arthroplasty. J Arthroplasty. 2017;32(9s):S197-s201.PubMedCrossRef
15.
Neuwirth AL, Boddapati V, Held MB, Grosso MJ, Shah RP, Geller JA, et al. Preoperative anemia is associated with 30-day morbidity in total knee arthroplasty. Orthopedics. 2022;45(2):e86–90.PubMedCrossRef
16.
Karas V, Kildow BJ, Baumgartner BT, Green CL, Attarian DE, Bolognesi MP, et al. Preoperative patient profile in total hip and knee arthroplasty: predictive of increased medicare payments in a bundled payment model. J Arthroplasty. 2018;33(9):2728-33.e3.PubMedCrossRef
17.
Gu A, Malahias MA, Selemon NA, Wei C, Gerhard EF, Cohen JS, et al. Increased severity of anaemia is associated with 30-day complications following total joint replacement. Bone Jt J. 2020;102-b(4):485–94.CrossRef
18.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358: j4008.PubMedPubMedCentralCrossRef
19.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.PubMedPubMedCentralCrossRef
20.
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.PubMedPubMedCentralCrossRef
21.
Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol. 2011;64(4):380–2.PubMedCrossRef
22.
Bhandari M, Bajammal S, Guyatt GH, Griffith L, Busse JW, Schünemann H, et al. Effect of bisphosphonates on periprosthetic bone mineral density after total joint arthroplasty. A meta-analysis. J Bone Jt Surg Am. 2005;87(2):293–301.CrossRef
23.
Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta-analysis. JAMA. 2006;295(6):676–80.PubMedCrossRef
24.
Kasivisvanathan R, Ramesh V, Rao Baikady R, Nadaraja S. Preoperative anaemia is associated with increased allogeneic pack red cell transfusion in revision hip and knee joint arthroplasty: a retrospective analysis of 5387 patients over a 10-year period at a single high volume centre. Transfus Med. 2016;26(4):271–7.PubMedCrossRef
25.
Myers E, O’Grady P, Dolan AM. The influence of preclinical anaemia on outcome following total hip replacement. Arch Orthop Trauma Surg. 2004;124(10):699–701.PubMedCrossRef
26.
Rogers BA, Cowie A, Alcock C, Rosson JW. Identification and treatment of anaemia in patients awaiting hip replacement. Ann R Coll Surg Engl. 2008;90(6):504–7.PubMedPubMedCentralCrossRef
27.
Saleh E, McClelland DB, Hay A, Semple D, Walsh TS. Prevalence of anaemia before major joint arthroplasty and the potential impact of preoperative investigation and correction on perioperative blood transfusions. Br J Anaesth. 2007;99(6):801–8.PubMedCrossRef
28.
Sandean D, Chatterji U, Qureshi H, Power R, Samaras M. Immediate haemoglobin testing in association with a dedicated anaemia clinic: effectiveness for primary total knee replacement patients. J Perioper Pract. 2022;32(12):332–7.PubMed
29.
Sandean D, Samaras M, Chatterji U, Power R, Qureshi H. Reducing blood transfusions in primary total hip replacement patients: effectiveness of near-patient testing and a dedicated preoperative anemia clinic. Rev Bras Ortop (Sao Paulo). 2022;57(4):569–76.PubMed
30.
Xiong X, Li T, Cheng B. Anemia and formation of deep vein thrombosis before operation in patients with knee osteoarthritis: a cross-sectional study. J Orthop Surg Res. 2023;18(1):33.PubMedPubMedCentralCrossRef
31.
Greenky M, Gandhi K, Pulido L, Restrepo C, Parvizi J. Preoperative anemia in total joint arthroplasty: Is it associated with periprosthetic joint infection? Clin Orthop Relat Res. 2012;470(10):2695–701.PubMedPubMedCentralCrossRef
32.
Viola J, Gomez MM, Restrepo C, Maltenfort MG, Parvizi J. Preoperative anemia increases postoperative complications and mortality following total joint arthroplasty. J Arthroplasty. 2015;30(5):846–8.PubMedCrossRef
33.
Abdullah HR, Ranjakunalan N, Yeo W, Tan MH, Poopalalingam R, Sim YE. Association between preoperative anaemia and blood transfusion with long-term functional and quality of life outcomes amongst patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study. Qual Life Res. 2019;28(1):85–98.PubMedCrossRef
34.
Lasocki S, Krauspe R, von Heymann C, Mezzacasa A, Chainey S, Spahn DR. PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study. Eur J Anaesthesiol. 2015;32(3):160–7.PubMedCrossRef
35.
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):480–5.PubMedCrossRef
36.
Meybohm P, Kohlhof H, Wirtz DC, Marzi I, Füllenbach C, Choorapoikayil S, et al. Preoperative anaemia in primary hip and knee arthroplasty. Z Orthop Unfall. 2020;158(2):194–200.PubMedCrossRef
37.
Schatz C, Plötz W, Beckmann J, Bredow K, Leidl R, Buschner P. Associations of preoperative anemia and postoperative hemoglobin values with hospital costs in total knee arthroplasty (TKA). Arch Orthop Trauma Surg. 2023;143:1–11.CrossRef
38.
Bailey A, Eisen I, Palmer A, Beaulé PE, Fergusson DA, Grammatopoulos G. Preoperative anemia in primary arthroplasty patients-prevalence, influence on outcome, and the effect of treatment. J Arthroplasty. 2021;36(7):2281–9.PubMedCrossRef
39.
Duarte GC, Catanoce AP, Zabeu JL, Ribeiro GN, Moschen M, de Oliveira NAG, et al. Association of preoperative anemia and increased risk of blood transfusion and length of hospital stay in adults undergoing hip and knee arthroplasty: an observational study in a single tertiary center. Health Sci Rep. 2021;4(4): e448.PubMedPubMedCentralCrossRef
40.
Wan S, Sparring V, Cabrales DA, Jansson K, Wikman A. Clinical and budget impact of treating preoperative anemia in major orthopedic surgery-a retrospective observational study. J Arthroplasty. 2020;35(11):3084–8.PubMedCrossRef
41.
Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Jt Surg Am. 1999;81(1):2–10.CrossRef
42.
Dunne JR, Malone D, Tracy JK, Gannon C, Napolitano LM. Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery. J Surg Res. 2002;102(2):237–44.PubMedCrossRef
43.
Gruson KI, Aharonoff GB, Egol KA, Zuckerman JD, Koval KJ. The relationship between admission hemoglobin level and outcome after hip fracture. J Orthop Trauma. 2002;16(1):39–44.PubMedCrossRef
44.
Hagino T, Ochiai S, Sato E, Maekawa S, Wako M, Haro H. The relationship between anemia at admission and outcome in patients older than 60 years with hip fracture. J Orthop Traumatol. 2009;10(3):119–22.PubMedPubMedCentralCrossRef
45.
Prochaska MT, Huisingh-Scheetz M, Meltzer D. Sex differences in fatigue and symptoms of anemia in relation to hemoglobin level in hospitalized patients. Ann Hematol. 2022;101(8):1873–5.PubMedPubMedCentralCrossRef
46.
Kanias T, Busch MP. Diversity in a blood bag: application of omics technologies to inform precision transfusion medicine. Blood Transfus. 2019;17(4):258–62.PubMedPubMedCentral
47.
Schwartzberg LS, Fortner BV, Houts AC. Sex differences in patients who have cancer with mild anemia: symptom burden and quality of life. Support Cancer Ther. 2005;2(4):241–6.PubMedCrossRef
48.
Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20(11):725–30.PubMedCrossRef
49.
Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008;23(7):984–91.PubMedCrossRef
50.
Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood. 2009;113(15):3406–17.PubMedCrossRef
51.
Seicean A, Alan N, Seicean S, Neuhauser D, Weil RJ. The effect of blood transfusion on short-term, perioperative outcomes in elective spine surgery. J Clin Neurosci. 2014;21(9):1579–85.PubMedCrossRef
52.
Potaczek DP, Jankowska EA, Wypasek E, Undas A. Iron deficiency: a novel risk factor of recurrence in patients after unprovoked venous thromboembolism. Pol Arch Med Wewn. 2016;126(3):159–65.PubMed
53.
Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e278S-e325S.PubMedPubMedCentralCrossRef
54.
Bala A, Huddleston JI 3rd, Goodman SB, Maloney WJ, Amanatullah DF. Venous thromboembolism prophylaxis after TKA: Aspirin, warfarin, enoxaparin, or factor Xa inhibitors? Clin Orthop Relat Res. 2017;475(9):2205–13.PubMedPubMedCentralCrossRef
55.
Barshtein G, Ben-Ami R, Yedgar S. Role of red blood cell flow behavior in hemodynamics and hemostasis. Expert Rev Cardiovasc Ther. 2007;5(4):743–52.PubMedCrossRef
56.
Meizoso JP, Karcutskie CA, Ray JJ, Ruiz X, Ginzburg E, Namias N, et al. A simplified stratification system for venous thromboembolism risk in severely injured trauma patients. J Surg Res. 2017;207:138–44.PubMedCrossRef
57.
Wang P, Kandemir U, Zhang B, Wang B, Li J, Zhuang Y, et al. Incidence and risk factors of deep vein thrombosis in patients with pelvic and acetabular fractures. Clin Appl Thromb Hemost. 2019;25:1076029619845066.PubMedPubMedCentral
58.
Zhang H, Wu L, Cheng B. Preoperative anemia and deep vein thrombosis in patients with perioperative bone trauma: a cohort study. BMC Musculoskelet Disord. 2022;23(1):905.PubMedPubMedCentralCrossRef
59.
Froessler B, Palm P, Weber I, Hodyl NA, Singh R, Murphy EM. The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial. Ann Surg. 2016;264(1):41–6.PubMedCrossRef
60.
61.
Beyer I, Compté N, Busuioc A, Cappelle S, Lanoy C, Cytryn E. Anemia and transfusions in geriatric patients: a time for evaluation. Hematology. 2010;15(2):116–21.PubMedCrossRef
62.
Safiri S, Kolahi AA, Noori M, Nejadghaderi SA, Karamzad N, Bragazzi NL, et al. Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019. J Hematol Oncol. 2021;14(1):185.PubMedPubMedCentralCrossRef
63.
Metadata
Title
Impact of preoperative anemia on patients undergoing total joint replacement of lower extremity: a systematic review and meta-analysis
Authors
Fu-Qiang Zhang
Yong-Ze Yang
Peng-Fei Li
Guo-Rong Ma
An-Ren Zhang
Hui Zhang
Hong-Zhang Guo
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
Anemia
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-024-04706-y

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