Incidence and Risk Factors for Blood Transfusion in Simultaneous Bilateral Total Joint Arthroplasty: A Multicenter Retrospective Study
Incidence and Risk Factors for Blood Transfusion in Simultaneous Bilateral Total Joint Arthroplasty: A Multicenter Retrospective Study
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DOI：
10.1016/j.arth.2018.02.041
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发表时间：
2018-07-01
影响因子：
3.5
通讯作者：
Pei, Fuxing
中科院分区：
文献类型：
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作者：
Cao, Guorui;Huang, Zeyu;Pei, Fuxing
背景：本研究的目的是确定同时双侧全髋关节置换术（SBTHA）和同时双侧全膝关节置换术（SBTKA）患者输血的发生率和危险因素。方法：我们确定了414例SBTHA和1147例SBTKA手术，并将患者分为需要输血和不需要输血的患者。采用多变量logistic回归模型确定输血的独立危险因素。结果：SBTHA术后输血率为50.0%，输血的显著危险因素为女性（优势比[OR] = 2.612）、较低体重指数（OR = 1.093）、炎症性关节炎（OR = 1.970）、美国麻醉学会(ASA) >= 3级（OR = 3.477）、引流管使用（OR = 4.607）、术中出血增加。我们还发现术前较高的血红蛋白（Hb）和氨甲环酸的使用降低了输血的风险。SBTKA术后输血率为29.1%，输血的显著危险因素为ASA分级>= 3 （OR = 8.959）、止血带使用（OR = 2.129）、引流管使用（OR = 4.970）和术中出血增加。较高的术前血红蛋白是输血的唯一保护因素。结论：SBTHA的危险因素为女性、低体重指数、炎性关节炎、ASA分级>= 3、使用引流管、术中出血量增加；SBTKA的危险因素为ASA分级>= 3、使用止血带、使用引流管、术中出血量增加。提高术前血红蛋白水平可降低输血风险。此外，鼓励使用氨甲环酸来减少SBTHA的输血需求。(C) 2018爱思唯尔公司版权所有。
Background: The aim of this study was to identify the incidence and risk factors for blood transfusion in patients undergoing simultaneous bilateral total hip arthroplasty (SBTHA) and simultaneous bilateral total knee arthroplasty (SBTKA).Methods: We identified 414 SBTHA and 1147 SBTKA procedures, and separated the patients into those who did and did not require allogeneic blood transfusion. A multivariate logistic regression model was used to identify independent risk factors for transfusion.Results: The transfusion rate after SBTHA was 50.0%, and significant risk factors for transfusion were female gender (odds ratio [OR] = 2.612), lower body mass index (OR = 1.093), inflammatory arthritis (OR = 1.970), American Society of Anesthesiologists (ASA) class >= 3 (OR = 3.477), drain use (OR = 4.607), and increased intraoperative bleeding. We also found that higher preoperative hemoglobin (Hb) and tranexamic acid use decreased the risk of transfusion. The transfusion rate after SBTKA was 29.1%, and significant risk factors for transfusion were ASA class >= 3 (OR = 8.959), tourniquet use (OR = 2.129), drain use (OR = 4.970), and increased intraoperative bleeding. A higher preoperative Hb was the only protective factor for transfusion.Conclusion: For SBTHA, the risk factors included female gender, lower body mass index, inflammatory arthritis, ASA class >= 3, drain use, and increased intraoperative bleeding, while for SBTKA, risk factors were ASA class >= 3, tourniquet use, drain use, and increased intraoperative bleeding. Increasing the preoperative Hb level may decrease transfusion risk. In addition, tranexamic acid was encouraged to use to decrease transfusion need in SBTHA. (C) 2018 Elsevier Inc. All rights reserved.