Predictive Factors for Blood Transfusion after Total Knee Arthroplasty<sup/>

Mozella, Alan de Paula; Cobra, Hugo Alexandre de Araújo Barros; Duarte, Maria Eugênia Leite

doi:10.1055/s-0040-1715511

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Sumário

Original Article • Rev. bras. ortop. 56 (4) • Jul-Aug 2021 • https://doi.org/10.1055/s-0040-1715511 copy

Predictive Factors for Blood Transfusion after Total Knee Arthroplasty^* * Work developed at Centro de Cirurgia do Joelho do Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil.

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Abstract

Objectives

The present paper aims to (1) verify the incidence and volume of blood transfusion among patients undergoing unilateral cemented total knee arthroplasty (TKA) in a single Brazilian reference center; (2) identify pre and perioperative variables to determine subjects with higher risk (i.e., predictive factors) for blood transfusion within 48 hours following surgery; (3) estimate the risk of blood transfusion during the first 48 hours after the procedure.

Methods

The initial sample consisted of all patients undergoing TKA from August 2010 to August 2013. After applying the exclusion criteria, 234 patients aged 30 to 83 years old and diagnosed with primary or secondary osteoarthritis due to rheumatoid arthritis remained in the study.

Results

Preoperative hemoglobin levels ≤12.3 g/dL and ischemia time ≥87 minutes were independent predictors for post-TKA blood transfusion, with a relative risk of 2.48 and 1.78, respectively. Approximately half of the TKA patients (51.3%) presenting these two variables required a blood transfusion.

Conclusion

The incidence of post-TKA blood transfusion was 33.7%. On average, each transfused patient received 480 mL of packed red blood cells. Preoperative hemoglobin levels ≤12.3 g/dL (p < 0.001) and ischemia time ≥87 minutes (p < 0.047) were independent predictors for blood transfusion in TKA using a pneumatic cuff, with a relative risk of 2.48 and 1.78, respectively. Age, gender, diagnosis, or body mass index were not considered independent predictors for the need for blood transfusion upto 48 hours after the procedure.

Keywords:
arthroplasty, replacement, knee; blood transfusion; osteoarthritis, knee

	T group (n = 79)	nT group (n = 155)	p-value
Age^* * Student’s t-test for independent samples or Mann-Whitney test.	67.6 ± 9.3	66.1 ± 9.0	0.23
Gender^ χ2 or Fisher exact test.
Male	10 (12.7%)	33 (21.3%)	0.10
Female	69 (87.3%)	122 (78.7%)	0.10
Diagnosis^ χ2 or Fisher exact test.
RA	10 (12.7%)	28 (18.5%)	0.25
OA	69 (87.3%)	123 (81.5%)	0.25
BMI (kg/m²2 Marulanda GA, Ragland PS, Seyler TM, Mont MA. Reductions in blood loss with use of a bipolar sealer for hemostasis in primary total knee arthroplasty. Surg Technol Int 2005;14:281–286)^* * Student’s t-test for independent samples or Mann-Whitney test.	30 ± 5.4	30.2 ± 5.3	0.71
ASA^ χ2 or Fisher exact test.
1	3	11	0.49
2	75	139
3	1	5

Variable	T group (n = 79)		nT group (n = 155)		p-value^a a Student t-test for independent samples.
Age (years old)	67.6 ± 9.3	(40–83)	66.1 ± 9.0	(30–82)	0.23
BMI (kg/m²)	30.0 ± 5.4	(20.8–44.9)	30.2 ± 5.3	(15.0–43.8)	0.71
Ischemia time (minutes)	94.5 ± 21.0	(50–150)	87.0 ± 20.2	(40–135)	0.0014

Variable	T group (n = 79)		nT group (n = 155)		p-value^a a χ2 or Fisher exact test.
Gender
Male	10	12.7%	33	21.3%	0.10
Female	69	87.3	122	78.7	0.10
Diagnosis
OA	69	87.3	122	78.7	0.25
RA	10	12.7	33	21.3	0.25
Surgical Risk
ASA 1	3	3.9	11	7.1	0.49
ASA 2	74	94.9	139	89.7
ASA 3	1	1.3	5	3.2

Variable	T group		nT group		p-value^a a Student t-test for independent samples.
Male gender	n = 10		n = 33
Preoperative Hb (g/dL)	12.9 ± 0.7	(11.8–14.1)	13.8 ± 1.4	(11.2–16.7)	0.046
Postoperative Hb (g/dL)	8.0 ± 1.1	(6.7–10)	9.9 ± 1.5	(7.3–14.2)	0.0007
Δ Hb (g/dL)¹ 1 Absolute Δ = preoperative Hb – postoperative Hb.	5.0 ± 1.1	(6.7–3)	4.0 ± 1.3	(6.7–1.1)	0.033
Δ Hb (%)² 2 Relative Δ (%) = absolute Δ / preoperative Hb * 100.	38.3 ± 8.0	(50–24)	28.7 ± 8.7	(48–9.4)	0.003
Female gender	n = 69		n = 122
Preoperative Hb (g/dL)	11.9 ± 1.3	(9.3–14.8)	12.4 ± 1.2	(8.7–16.1)	0.002
Postoperative Hb (g/dL)	7.8 ± 1.0	(5.8–10.9)	9.1 ± 1.4	(6.1–12.3)	0.0001
Δ Hb (g/dL)¹ 1 Absolute Δ = preoperative Hb – postoperative Hb.	4.1 ± 1.6	(7.4–1.3)	3.3 ± 1.4	(8.2–1.1)	0.0005
Δ Hb (%)² 2 Relative Δ (%) = absolute Δ / preoperative Hb * 100.	34.0 ± 10.5	(54–12.7)	26.5 ± 9.8	(51–9.1)	0.0001

Preoperative hemoglobin level ≤ 12.3 g/dL	Ischemia time ≥ 87 minutes	Estimated probability (%)	95% Confidence interval
No	No	19.3	12.4–28.9
No	Yes	29.9	20.8–40.8
Yes	No	37.2	26.4–49.4
Yes	Yes	51.3	40.0–62.6

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Alan de Paula Mozella, M.D., M.Sc., Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Av. Brasil, 500, Caju, Rio de Janeiro, RJ, 20940-070, Brazil (e-mail: apmozella@terra.com.br).

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Predictive Factors for Blood Transfusion after Total Knee Arthroplasty* * Work developed at Centro de Cirurgia do Joelho do Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil.

Abstract

Objectives

Methods

Results

Conclusion

Predictive Factors for Blood Transfusion after Total Knee Arthroplasty^* * Work developed at Centro de Cirurgia do Joelho do Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil.