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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Total knee Arthroplasty: risk factors for allogeneic blood transfusions in the South Asian population

Authors: Syed Hamza Mufarrih, Nada Qaisar Qureshi, Arif Ali, Azeem Tariq Malik, Huda Naim, Shahryar Noordin

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

Total knee arthroplasty (TKA) is the recommended treatment for end-stage knee osteoarthritis. Considering the various risks associated with intra and postoperative blood transfusions, better understanding is required with respect to the risk factors contributing to a greater possibility of blood transfusion during or after surgery. Although literature highlights several such factors, our study is among the first to identify these risk factors in the South Asian population which differs from other populations in several ways.

Methods

The study consists of a review of 658 patients undergoing TKA from 2005 to 2015. Data was obtained from patient medical records and was analysed using logistic regression analysis. The relationship between each predictor and the outcome variable was calculated as an Odds ratio (OR), the threshold of significance for which was p = 0.25 and p = 0.05 for univariate and multivariable analysis respectively.

Results

The mean age of the patient population was 63 years (78% female), 25% of whom received one or more blood transfusions. Multivariable analysis revealed 5 significant independent predictors for increased risk of blood transfusions including bilateral knee surgery (OR:5.51), preoperative anemia (OR:4.15), higher ASA (American Society of Anaesthesiologists) status (3–4) (OR:1.92), female sex (OR:3.44) and BMI (Body mass index) ≤30 (OR:1.79) while increasing co-morbidities and age (>60) were found to be insignificant.

Conclusions

The factors identified for the South Asian population are largely similar to those for other populations. Identification of high risk patients will permit the application of an international multipronged approach which not only targets the modifiable risk factors but also the decision making process and blood management protocols in order to minimize the transfusion associated risks for a patient undergoing a TKA.
Literature
1.
2.
Nichols CI, Vose JG. Comparative risk of transfusion and incremental Total hospitalization cost for primary unilateral, bilateral, and revision Total knee Arthroplasty procedures. J Arthroplast. 2016;31(3):583–9. e1CrossRef
3.
4.
Romagnoli S, et al. Onsets of complications and revisions are not increased after simultaneous bilateral unicompartmental knee arthroplasty in comparison with unilateral procedures. Int Orthop. 2015;39(5):871–7.CrossRefPubMed
5.
6.
Brito SA, Rankin EA, McNear M. Acute blood loss anemia in the octogenarian Total knee Arthroplasty, estimated blood loss and transfusions rates. J Natl Med Assoc. 2016;108(1):86–9.CrossRefPubMed
7.
Hatzidakis AM, et al. Preoperative autologous donation for total joint arthroplasty. An analysis of risk factors for allogenic transfusion. J Bone Joint Surg. 2000;82(1):89–100.CrossRefPubMed
8.
Hart A, et al. Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am. 2014;96(23):1945–51.CrossRefPubMed
9.
Ntzani EE, et al. Consistency of genome-wide associations across major ancestral groups. Hum Genet. 2012;131(7):1057–71.CrossRefPubMed
10.
Ma C. Current antithrombotic treatment in East Asia: some perspectives on anticoagulation and antiplatelet therapy. Thromb Haemost. 2012;107(6):1014.CrossRefPubMed
11.
Ross AM, et al. A randomized trial confirming the efficacy of reduced dose recombinant tissue plasminogen activator in a Chinese myocardial infarction population and demonstrating superiority to usual dose urokinase: the TUCC trial. Am Heart J. 2001;142(2):244–7.CrossRefPubMed
12.
Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction. Randomised placebo-controlled trial. Lancet. 2005;366(9497):1607–21.CrossRef
13.
Flint J, et al. 1 the population genetics of the haemoglobinopathies. Baillière's Clin Haematol. 1998;11(1):1–51.CrossRef
14.
DeMaeyer E, Adiels-Tegman M. The prevalence of anaemia in the world. La prevalence de lanemie dans le monde. World health statistics quarterly. Rapport Trimestriel de Stat Sanitaires Mondiales. 1985;38(3):302–16.
15.
16.
Angastiniotis M, Modell B. Global epidemiology of hemoglobin disorders. Annals New York Acad Sci. 1998;850(1):251–69.CrossRef
17.
McLean E, et al. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993–2005. Public Health Nutr. 2009;12(4):444.CrossRefPubMed
18.
Dodani S. Excess coronary artery disease risk in south Asian immigrants: can dysfunctional high-density lipoprotein explain increased risk? Vascular Health Risk Manag. 2008;4(5):953.CrossRef
19.
Misra A, Khurana L. Obesity-related non-communicable diseases: south Asians vs white Caucasians. Inter J Obes. 2011;35(2):167–87.CrossRef
20.
Grant P. Diabetes mellitus as a prothrombotic condition. J Int Med. 2007;262(2):157–72.CrossRef
21.
Davidson EM, et al. Consideration of ethnicity in guidelines and systematic reviews promoting lifestyle interventions: a thematic analysis. European J Public Health. 2014;24(3):508–13.CrossRef
22.
Stehling L, et al. Practice guidelines for blood component therapy-a report by the American Society of Anesthesiologists Task Force on blood component therapy. Anesthesiol. 1996;84(3):732–47.CrossRef
23.
Retter A, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. British J Haematol. 2013;160(4):445–64.CrossRef
24.
Sekar S, et al. Dietary fats and osteoarthritis: insights, evidences, and new horizons. J Cell Biochem. 2017;118(3):453–63.CrossRefPubMed
25.
26.
Pereira D, et al. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthr Cartil. 2011;19(11):1270–85.CrossRefPubMed
27.
Anderson JG, et al. Functional outcome and patient satisfaction in total knee patients over the age of 75. J Arthropl. 11(7):831–40.
28.
Wylde V, et al. Total knee replacement: is it really an effective procedure for all? Knee. 2007;14(6):417–23.CrossRefPubMed
29.
Ngo LT, Bruhn R, Custer B. Risk perception and its role in attitudes toward blood transfusion: a qualitative systematic review. Transfus Med Rev. 2013;27(2):119–28.CrossRefPubMed
30.
Schoettker P, et al. Revisiting transfusion safety and alternatives to transfusion. Presse Med. 2016;45(7–8):e331–40. Pt 2CrossRefPubMed
31.
Bierbaum BE, et al. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am. 1999;81(1):2–10.CrossRefPubMed
32.
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.CrossRefPubMed
33.
Rasouli MR, et al. Blood management after total joint arthroplasty in the United States: 19-year trend analysis. Transfusion. 2016;56(5):1112–20.CrossRefPubMed
34.
Bould M, et al. Blood loss in sequential bilateral total knee arthroplasty. The Journal Arthroplasty. 1998;13(1):77–9.CrossRef
35.
March LM, et al. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthr Cartil. 2004;12(5):400–8.CrossRefPubMed
36.
Reuben JD, et al. Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty. J Arthroplast. 1998;13(2):172–9.CrossRef
37.
Restrepo C, et al. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2007;89(6):1220–6.CrossRefPubMed
38.
Ritter MA, et al. Simultaneous bilateral, staged bilateral, and unilateral total knee arthroplasty. A survival analysis. J Bone Joint Surg Am. 2003;85-A(8):1532–7.CrossRefPubMed
39.
Morais S, et al. Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach. Int Orthop. 2014;38(2):347–54.CrossRefPubMed
40.
Salido JA, et al. Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. J Bone Joint Surg Am. 2002;84-A(2):216–20.CrossRefPubMed
41.
Rashiq S, et al. Predicting allogeneic blood transfusion use in total joint arthroplasty. Anesth Analg. 2004;99(4):1239–44. table of contentsCrossRefPubMed
42.
Larocque BJ, Gilbert K, Brien WF. A point score system for predicting the likelihood of blood transfusion after hip or knee arthroplasty. Transfusion. 1997;37(5):463–7.CrossRefPubMed
43.
Ogbemudia AE, et al. Preoperative predictors for allogenic blood transfusion in hip and knee arthroplasty for rheumatoid arthritis. Arch Orthop Trauma Surg. 2013;133(9):1315–20.CrossRefPubMed
44.
Jiganti JJ, Goldstein WM, Williams CS. A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient. Clin Orthop Relat Res. 1993;289:175–9.
45.
Noticewala MS, et al. Predicting need for allogeneic transfusion after total knee arthroplasty. J Arthroplast. 2012;27(6):961–7.CrossRef
46.
Park JH, et al. Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am. 2013;95(19):1777–83.CrossRefPubMed
47.
Na HS, et al. Effects of intravenous iron combined with low-dose recombinant human erythropoietin on transfusion requirements in iron-deficient patients undergoing bilateral total knee replacement arthroplasty. Transfusion. 2011;51(1):118–24.CrossRefPubMed
48.
Cuenca J, et al. Preoperative haematinics and transfusion protocol reduce the need for transfusion after total knee replacement. Int J Surg. 2007;5(2):89–94.CrossRefPubMed
49.
Mercuriali F, et al. Use of recombinant human erythropoietin to assist autologous blood donation by anemic rheumatoid arthritis patients undergoing major orthopedic surgery. Transfusion. 1994;34(6):501–6.CrossRefPubMed
50.
Keating EM, et al. Predictors of transfusion risk in elective knee surgery. Clin Orthop Relat Res. 1998;357:50–9.CrossRef
51.
Bong MR, et al. Risks associated with blood transfusion after total knee arthroplasty. J Arthroplast. 2004;19(3):281–7.CrossRef
52.
Daabiss M. American Society of Anaesthesiologists physical status classification. Indian Journal Anaesthesia. 2011;55(2):111.CrossRef
53.
Agarwalla R, et al. Assessment of prevalence of anemia in and its correlates among community-dwelling elderly of Assam, India: a cross-sectional study. Int J Nutrition, Pharmacol, Neurological Diseases. 2016;6(1):23–7.CrossRef
54.
Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br. 2004;86(4):561–5.PubMed
55.
Frisch N, et al. Effect of body mass index on blood transfusion in Total hip and knee Arthroplasty. Orthopedics. 2016;39(5):e844–9.CrossRefPubMed
56.
Tsuboi I, Harada T, Aizawa S. Age-related functional changes in hematopoietic microenvironment. J Physical Fitness Sports Med. 2016;5(2):167–75.CrossRef
57.
Goodnough LT, et al. Transfusion medicine. Second of two parts--blood conservation. N Engl J Med. 1999;340(7):525–33.CrossRefPubMed
Metadata
Title
Total knee Arthroplasty: risk factors for allogeneic blood transfusions in the South Asian population
Authors
Syed Hamza Mufarrih
Nada Qaisar Qureshi
Arif Ali
Azeem Tariq Malik
Huda Naim
Shahryar Noordin
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1728-5

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