scholarly journals Risk Factors for Blood Transfusion After Primary Total Hip Arthroplasty

2019 ◽  
Vol 9 ◽  
Author(s):  
Kyle K. Kesler ◽  
Timothy S. Brown ◽  
J. Ryan Martin ◽  
Bryan D. Springer ◽  
Jesse Otero
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Total Hip Arthroplasty ◽  
Blood Transfusion ◽  
Hip Arthroplasty ◽  
Univariate Analysis ◽  
Chronic Obstructive ◽  
Complication Rates ◽  
Improvement Project ◽  
Total Hip

Aims: In the setting of rising healthcare costs, more cost efficiency in total hip arthroplasty (THA) is required. Following THA, most patients are monitored with serial hemoglobin testing despite few needing blood transfusions.  This testing adds cost and may not be necessary in most patients.  This study aims to identify factors associated with transfusion, therefore guiding hemoglobin monitoring following THA.Patients and Methods: Patients who underwent primary THA in 2015 were identified using the National Surgical Quality Improvement Project (NSQIP) database.  Patient discharged on the day of surgery were excluded. Patients were classified into those receiving transfusion versus no transfusion. Demographics and comorbidities were compared between groups followed by univariate and multivariate analysis, allowing identification of patient characteristics and comorbidities associated with transfusion. Results: Overall, 28664 patients who underwent THA patients were identified.  Within this group, 6.1% (n=1737) had a post-operative transfusion.  Patients receiving a blood transfusion were older, had lower body mass index, and had higher rates of chronic obstructive pulmonary disease (COPD), heart failure, dialysis, prior transfusion, and were more frequently ASA class 3-4 (p<0.001).  Univariate analysis demonstrated that patients requiring transfusion had higher complication rates (4.3% vs. 12.8%, p<0.0001).  Multivariate analysis identified age >70, diabetes, smoking, COPD, prior transfusion, and operative time >2 hours as independent risk factors for transfusion.Conclusion: Among THA patients, characteristics and comorbidities exist that are associated with increased likelihood of transfusion.  Presence of these factors should guide hemoglobin monitoring post-operatively. Selective hemoglobin monitoring can potentially decrease the cost of THA. 

Relative Risk Factors for Requirement of Blood Transfusion after Total Hip Arthroplasty

2007 ◽  
Vol 22 (8) ◽  
pp. 1162-1167 ◽  
Author(s):  
Michael Walsh ◽  
Charles Preston ◽  
Matthew Bong ◽  
Vipul Patel ◽  
Paul E. Di Cesare
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Total Hip Arthroplasty ◽  
Blood Transfusion ◽  
Hip Arthroplasty ◽  
Total Hip

Decline in allogeneic blood transfusion usage in total hip arthroplasty patients: National Inpatient Sample 2009 to 2013

2017 ◽  
Vol 28 (4) ◽  
pp. 382-390 ◽  
Author(s):  
Chukwuweike U. Gwam ◽  
Jaydev B. Mistry ◽  
Jennifer I. Etcheson ◽  
Nicole E. George ◽  
Grayson Connors ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Blood Transfusion ◽  
Hip Arthroplasty ◽  
Allogeneic Blood Transfusion ◽  
Allogeneic Blood ◽  
National Inpatient Sample ◽  
Allogeneic Transfusion ◽  
Total Hip ◽  
Primary Thas

Introduction: Although total hip arthroplasty (THA) is an effective treatment for end-stage arthritis, it is also associated with substantial blood loss that may require allogeneic blood transfusion. However, these transfusions may increase the risk of certain complications. The purpose of our study is to evaluate: (i) the incidence/trends of allogeneic blood transfusion; (ii) the associated risk factors and adverse events; and (iii) the discharge disposition, length of stay (LOS), and costs for these patients between 2009 and 2013. Methods: The National Inpatient Sample database was used to identify 1,542,366 primary THAs performed between 2009 and 2013. Patients were stratified based on demographics, economic data, hospital characteristics, comorbidities, and whether or not allogeneic transfusion was received. Logistic regression was performed to evaluate the risk factors for transfusion and postoperative complications. Results: From 2009 to 2013, allogeneic transfusions were used in 16.9% of primary THAs, with a declining annual incidence. Except for obesity, all comorbidities were associated with increased likelihood of receiving a transfusion. Allogeneic transfusion patients were more likely to experience surgical site infections or pulmonary complications (p<0.001 for all). These patients were more likely to be discharged to a short-term care facility (p<0.001). Additionally, they had a greater mean LOS (p<0.001) and higher median hospital costs and charges when compared to their non-transfused counterparts. Conclusions: While the observed decline in allogeneic transfusion usage is encouraging, further efforts should focus on preoperative patient optimisation. Given the projected increase in demand for primary THAs, orthopaedic surgeons must be familiar with safe and effective blood conservation protocols.

Mepivacaine Spinal Anesthesia Facilitates Shorter Lengths of Stay and Fewer Urinary Complications in Total Hip Arthroplasty Compared to Bupivacaine

2020 ◽  
Vol 4 (03) ◽  
pp. 134-141
Author(s):  
Jonathan H. Shaw ◽  
M. Chad Mahan ◽  
Justin Jabara ◽  
Toufic R. Jildeh ◽  
Jason J. Davis
Keyword(s):  
Multivariate Analysis ◽  
Total Hip Arthroplasty ◽  
Spinal Anesthesia ◽  
Hip Arthroplasty ◽  
Univariate Analysis ◽  
Early Postoperative Period ◽  
Total Hip ◽  
Lengths Of Stay ◽  
Same Day Discharge ◽  
Neuraxial Complications

AbstractThe purpose of this study was to compare the shorter-acting spinal anesthetic mepivacaine versus bupivacaine in total hip arthroplasty (THA). We retrospectively reviewed a prospectively collected database from a single surgeon's contemporary cohort of 311 consecutive patients undergoing primary THA. Primary outcomes were urinary retention, length of stay (LOS), neuraxial complications, pain control, and opioid consumption. Statistical analysis with univariate logistic regression was performed followed by a multivariate analysis controlling for multiple factors to evaluate the effect of anesthetic on primary outcomes. The univariate analysis demonstrated those with mepivacaine required less postoperative catheterization (0.0 vs. 5.7%, p = 0.009). Multivariate analysis exhibited that the mepivacaine group had a higher average opioid requirement (morphine equivalence [MEQ] 0.64 ± 0.22 vs. 1.17 ± 0.23; p < 0.001), similar average pain scores (visual analog scale 1.96 ± 0.24 vs. 2.65 ± 0.25), a lower LOS (0.90 ± 0.15 vs. 1.19 ± 0.15, p < 0.001), and an almost 10 times higher chance for a same-day discharge (odds ratio 9.67, 3.72–25.15, p < 0.001). There were no neuraxial complications in either group and no need for conversion to general anesthesia with the shorter-acting mepivacaine. Mepivacaine for spinal anesthesia with THA produced a significant improvement in recovery time with less urinary complications, a shorter LOS, and a higher chance of same-day discharge. Pain was well controlled in both groups with slightly increased pain and MEQ in the early postoperative period.

Readmission for Early Prosthetic Dislocation after Primary Total Hip Arthroplasty

2020 ◽  
Vol 04 (01) ◽  
pp. 023-032
Author(s):  
Wesley M. Durand ◽  
William J. Long ◽  
Ran Schwarzkopf
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Operating Room ◽  
Hip Arthroplasty ◽  
Postoperative Management ◽  
Chronic Obstructive ◽  
Improvement Program ◽  
Obstructive Pulmonary Disease ◽  
Total Hip ◽  
Early Reoperation

AbstractProsthetic dislocation in total hip arthroplasty (THA) is the most common cause for readmission in the 90 days following surgery. This investigation sought to quantify risk factors for readmission for early prosthetic dislocation within 30 days after primary THA. This study used the National Surgical Quality Improvement Program (NSQIP) database for the years 2012 to 2017. The primary outcome was reoperation or readmission for prosthetic dislocation within 30 days after primary total hip replacement. Secondary outcomes included native NSQIP medical complications. A total of 159,234 patients were included. Of these, 0.25% (n = 399) experienced reoperation or readmission for prosthetic dislocation within 30 days postoperatively. A total of 217 dislocated hips (54.4%) returned to the operating room only once, and 27 hips (6.8%) returned to the operating room twice. The mean day of first reoperation/readmission for dislocation was 13.5 (standard deviation [SD]: 9.0). In multivariable logistic regression, the following factors were significantly associated with early reoperation/readmission for prosthetic dislocation: patient age 80+ years (odds ratio [OR]: 1.51 vs. 50–59), high creatinine (OR: 1.75 vs. normal range), smoking (OR: 1.53), history of severe chronic obstructive pulmonary disease (COPD) (OR: 1.73), general anesthesia (OR: 1.41 vs. spinal), American Society of Anesthesiologists (ASA) class 3–5 (OR: 1.66 vs. 1 or 2), fracture (OR: 2.17), chronic steroid use (OR: 1.54), and operative duration ≥ 2 hours (all p < 0.05). Early prosthetic dislocation was significantly associated with the further development of surgical site infection (OR: 2.25) (both p < 0.05). This study identified risk factors for early reoperation/readmission for prosthetic dislocation after THA. These findings have implications for preoperative planning, postoperative management, and dislocation precautions.

Epidemiological Study of Femoral Head Osteonecrosis

2017 ◽  
Vol 68 (5) ◽  
pp. 974-976
Author(s):  
Alexandru Patrascu ◽  
Liliana Savin ◽  
Dan Mihailescu ◽  
Victor Grigorescu ◽  
carmen Grierosu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Young Patients ◽  
Head Group ◽  
Bipolar Hemiarthroplasty ◽  
Aseptic Necrosis ◽  
Total Hip ◽  
Femoral Head Osteonecrosis

In recent years, there has been an increase in the number of studies on the etiology of femoral head necrosis. We retrospectively reviewed all patients diagnosed with aseptic necrosis of the femoral in the period of 2010-2015. We recorded a total of 230 cases diagnosed with aseptic necrosis of the femoral head, group was composed of 65.7% men and 34.3% women, risk factors identified was 19.13% (post-traumatic), 13.91% (glucocorticoids), 26.52% (alcohol), 3.47% (another cause) and in 36 95% of the cases no risk factors were found. The results of the study based on the type of surgery performed on the basis of stages of disease progression, 8 patients (3.48%) benefited from osteotomy, 28 patients (12.17%) benefited of bipolar hemiarthroplasty prosthesis and 188 patients (81.74%) benefited of total hip arthroplasty. Osteonecrosis of the femoral head is characteristic to young patients between the age of 30-50 years old. Predisposing factors, alcohol and corticosteroid therapy remains an important cause of the disease. Total hip arthroplasty remains the best option for the patients with osteonecrosis of the femoral head.

scholarly journals Risk factors in total hip arthroplasty and hemiarthroplasty: Infection and mortality

2021 ◽  
Vol 65 (4) ◽  
pp. 239-247
Author(s):  
A. Hernández-Aceituno ◽  
M. Ruiz-Álvarez ◽  
R. Llorente-Calderón ◽  
P. Portilla-Fernández ◽  
A. Figuerola-Tejerina
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Hip
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