Original Communication
Acute Blood Loss Anemia in the Octogenarian Total Knee Arthroplasty, Estimated Blood Loss and Transfusions Rates

https://doi.org/10.1016/j.jnma.2015.12.011Get rights and content

Introduction

Acute blood loss anemia is an expected morbidity after a total knee replacement. The purpose of this study is to quantify the rates of blood transfusions in the octogenarian population after a total knee replacement and its association with the surgeon’s estimated blood loss (EBL).

Methods

This is a retrospective review of the senior orthopedic surgeon’s charts. All patients were 80 years of age, or older at the time of surgical intervention. All patients with the diagnosis of primary osteoarthritis where included.

Results

A total 74 total knee arthroplasties were considered, in a total of 64 patients. Overall, 53% patients had an uneventful stay without a blood transfusion. The rates of transfusions increased with EBLs of 200, 250, and >250 ml with rates of 43%, 80%, and 55 % respectively. The average hematocrit of all patients that were transfused was 33.98, compared to 38.20 for the patients that were not transfused.

Conclusion

47% of patients required a blood transfusion during their hospital course regardless of the EBL estimated by the surgeon during surgery. The average hematocrit was found to be lower in the group that was transfused.

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Introduction

Acute blood loss anemia is an expected morbidity after a total knee replacement. Previous studies have considered tourniquets, surgical time, pre-operative hemoglobin levels and other factors, that influence the rates of blood transfusions after a total joint arthroplasty.1, 6, 7, 14, 15, 16 Blood transfusions are vital to the hospital course of these patients, especially in the elder population. A blood transfusion can further extend a patient’s hospital stay and delay participation in physical therapy. At the same time, it remedies acute blood loss anemia and provides hemodynamic stability in this patient population. To our knowledge no research paper has looked at estimated blood loss (EBL) alone and its association with blood transfusion rates in the octogenarian population after a total knee arthroplasty. The purpose of this study is to quantify the rates of blood transfusions in the octogenarian population after a total knee replacement and its association with the surgeon’s EBL.

Section snippets

Methods and Materials

Data for this study was obtained through the retrospective review of the senior orthopedic surgeon’s charts in private practice. IRB was not applicable because the research involved the collection and study of existing data and documents. In addition, the information was recorded by the investigator in such a manner that subjects cannot be identified directly, or through identifiers linked to the subjects. All patients were 80 years of age or older at the time of surgical intervention. The

Results

A total 74 total knee arthroplasties were considered in a total of 64 patients. The majority of patients were female. There were 56 females and 8 males. Five patients underwent sequential bilateral total knee arthroplasty under one anesthesia setting and another five patients returned at a later date for a contralateral knee arthroplasty. The age ranged from 80 to 93 years of age with an average age 84 years old. The average EBL was 186 milliliters (ml) for each patient having a single joint

Discussion

The elder population is one of the fastest growing populations in the US. In addition, the world’s population aged 80 and over is projected to increase 233 percent over the next 30 years.2, 5 Hence, quality of life of this elder population has become extremely important. Total knee arthroplasty have been proven to be a safe and cost effective surgical option in patients limited by the pain and sequela of primary osteoarthritis.3, 4 As the number of patients requiring joint replacement

Conclusion

Acute blood loss anemia is a common morbidity after a total knee in replacement. In this study of the octogenarian population, at least 47% of patients required a blood transfusion during their hospital course regardless of the EBL during surgery. However, similar to other age groups, the average hematocrit was found to be lower in the group that was transfused. Newer techniques may lower this over all transfusion rate. This study documents the experience of a single surgeon over a 17-year

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Financial disclosure: The authors above do not have any financial gain, conflicting interest, or commercial agreements or interest related to the publication to this manuscript.

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