Article
The correlations of allogenic transfusion to postoperative complications after total knee and total hip arthroplasty
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Authors
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Antonio Klasan
- Schwarzwald Baar Klinikum VS, Klinik für Orthopädie und Rheumaorthopädie, Donaueschingen, Germany
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Albert Benzing
- Schwarzwald Baar Klinikum VS, Klinik für Anästhesiologie und Intensivmedizin, Villingen-Schwenningen, Germany
| Published: | October 10, 2016 |
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Outline
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Objectives: Knee and hip replacement surgery are still the mainstay therapy for osteoarthritis. Despite of the improvement of techniques and implants, anemia is a relatively common complication, with transfusion rates of up to 23% in some centers. Due to a lack of data from Germany, we have decided to conduct a retrospective study of risk factors for a transfusion as well as correlation to complications.
Methods: In our ethical committee approved, retrospective, monocentrical study of 2760 unilateral primary knee and hip replacements in Germany, we have established a clear linear correlation between transfusion rate and complication rate as well as risk factors for receiving a transfusion. ANOVA, logistic regression and χ2 test have been used to perform the statistical analysis.
Results and Conclusion: 15% of all patients developed at least one complication. Transfusion rate was 9%, 4,9% after TKA, 10,94% after THA. Risk factors for receiving a transfusion were female gender, hip replacement, ASA >III, history of myocardial infarction, chronic cardiac disease, diabetes mellitus, chronic kidney disease, and length of surgery. The risk factors for developing a complication were: length of surgery, the procedure year, ASA score, presence of chronic renal insufficiency, and transfusion during hospital stay. Transfusion increases the risk of neurological (OR 7,2), gastrointestinal (OR 4,2), cardiovascular complications (OR 2,6), local infection (OR 5,88), pneumonia (OR 6,75) and acute kidney failure (OR 4,6). After adjusting for the order of occurrence, overall local infection rate without transfusion was 0,4% and with transfusion 2,82%.
These results were observed, with minor exceptions, in other newer orthopedic studies and in other surgical fields, throughout Europe and the USA. There are several explanations for these mechanisms, including haemolytic and non haemolytic immunological response and increased inflammation. Although the causality needs to be further investigated, the correlation is undeniable. We call for an even stricter indication for allogenic blood transfusion, use of alternatives such as EPO as well as better preoperative management of anaemia.
