Rationalized preoperative management of hip and knee arthroplasty patients: A retrospective cohort study
| Autor: | Thomas Prasloski, Jack Huang, Jacqueline D. Trudeau, Garrett Barry, John K. Peel, Bassam A. Masri, Lawrence Sham |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Receiver operating characteristic business.industry Program Efficiency medicine.medical_treatment Knee replacement Retrospective cohort study Perioperative Critical Care and Intensive Care Medicine Logistic regression Arthroplasty Surgery 03 medical and health sciences Medical–Surgical Nursing 0302 clinical medicine Anesthesiology and Pain Medicine Clinical pathway 030202 anesthesiology hemic and lymphatic diseases medicine 030212 general & internal medicine business |
| Zdroj: | Perioperative Care and Operating Room Management. 24:100177 |
| ISSN: | 2405-6030 |
| DOI: | 10.1016/j.pcorm.2021.100177 |
| Popis: | Background Current practices prioritize transfusion readiness over preoperative hemoglobin (Hgb) optimization in elective arthroplasty patients. We characterized the relationship between preoperative Hgb and perioperative transfusion among patients undergoing primary hip and knee replacement in order to identify a threshold Hgb at which the probability of transfusion is negligibly low. We then evaluated an alternative preoperative patient management algorithm using an evidence-guided threshold for pre-transfusion testing. Methods We performed a retrospective cohort study of adults undergoing elective primary hip or knee arthroplasty at two academic hospitals between 2010 and 2017. A subset of patients received either no treatment, iron supplementation, or erythropoietin preoperatively. Logistic regressions modelled the likelihood of transfusion, adjusted for baseline covariates. Receiver operating characteristic plots were generated to determine which Hgb threshold best predicted transfusion. Our results informed a quality-improvement initiative involving revised preoperative clinical pathway. Results We included 13,113 patients. A 10 g/L lower Hgb corresponded to 2.81 (95%CI: 2.43–3.25; p Conclusions Our results demonstrate that, at our center, a preoperative Hgb ≤115 g/L distinguishes between joint arthroplasty patients who require transfusion from those who do not. Patient-guided pretransfusion testing may streamline joint arthroplasty program efficiency. |
| Databáze: | OpenAIRE |
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