Predicting Perioperative Transfusion in Elective Hip and Knee Arthroplasty: A Validated Predictive Model
Josephine To1, Romi Sinha, Susan W Kim
1From the Division of Aged Care, Rehabilitation and Palliative Care, Modbury Hospital, Modbury, South Australia, Australia (J.T.); School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia (J.T.); Blood, Organ and Tissue Programs, Public Health and Clinical Systems, Department of Health, Adelaide, South Australia, Australia (R.S.); Faculty of Health Sciences (R.S.) and Flinders Centre for Epidemiology and Biostatistics, School of Medicine (S.W.K.), Flinders University, Bedford Park, South Australia, Australia; South Australia Bloodsafe Program, Adelaide, Australia (K.R.); Queen Elizabeth Hospital, Woodville, South Australia, Australia (K.R.); Departments of Haematology (B.K.) and Orthopaedics and Trauma (D.H.), Clinical Haematology Service (L.B.T.), and Clinical Section (L.B.T.), Royal Adelaide Hospital, Adelaide, South Australia, Australia; and Discipline of Orthopaedics and Trauma (D.H.) and Clinical Pathology (L.B.T.), University of Adelaide, Adelaide, South Australia, Australia.
Preoperative anemia and patient factors predict transfusion needs in hip and knee replacement surgery. A validated model can identify patients who may benefit from preoperative hemoglobin optimization to reduce transfusion requirements.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Preoperative anemia is a known predictor of perioperative erythrocyte transfusion in patients undergoing elective arthroplasty.
- However, the interplay between anemia and other patient/procedure characteristics in predicting transfusion needs remains understudied.
Purpose of the Study:
- To identify preoperative predictors of perioperative transfusion in patients undergoing elective primary total hip arthroplasty (THA) or total knee arthroplasty (TKA).
- To develop and validate a predictive model for transfusion requirements in this patient population.
Main Methods:
- A logistic regression model was developed using data from 737 adult patients undergoing elective THA or TKA at a tertiary hospital in Adelaide, Australia (January 2010 - June 2014).
- The model was externally validated using data from 653 patients from three additional Adelaide hospitals.
Main Results:
- Preoperative hemoglobin level (OR 0.51), undergoing total hip arthroplasty (OR 3.56), and being female aged 65 years or older (OR 3.37) were identified as significant predictors of transfusion.
- The model demonstrated predictive capability in the external validation cohort.
Conclusions:
- A validated model incorporating patient-specific preoperative variables can predict transfusion needs in elective hip and knee arthroplasty patients.
- This model may aid in identifying patients who could benefit from preoperative hemoglobin optimization to potentially decrease transfusion requirements.
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