Abstract
AIM:
Preoperative anemia in patients undergoing elective total knee arthroplasty has been associated with increased allogeneic blood transfusion therapy and increased rates of in hospital morbidity, which often leads to a longer length of hospital stay. We measured the prevalence of anaemia among patients attending pre-admission clinic before elective major joint arthroplasty.
METHODS:
Retrospectively, a randomized sample of all patients undergoing total hip arthroplasty between Dec 2009 and June 2010 were included. The computerized laboratory results were analysed for anaemia as defined by the local reference range (<11.5g/dL for females, <13g/dL for males). Patients were reviewed 6 weeks post operatively and range of flexion and extension was documented.
RESULTS:
96 patients were included with an average age of 67.2 years (SD 9.1). 54% were female; haematology data was complete for all patients. 13 (13.5%, 7 women) of these patients were anaemic on pre-admission haematological testing. There were two intra operative blood transfusions, both were in patients found to be anaemic pre-operatively. Overall, 23% of admissions were transfused an average of 2.2 (SD 0.39) units, an average of 2.2 (SD 1.2) days after surgery. Significantly, 71.4% of those patients identified as anaemic preoperatively were transfused post operatively, whereas only 23.1% of the pre-operatively non-anaemic patients were transfused (p = 0.0026 Fisher's exact test). The average length of stay for patients who were found to be anaemic at pre-operative assessment was 6.8 days (SD 3.5, range 4–13 days) compared to 4.9 days (SD 1.5, range 3–10 days) for the patient group that were not found to be anaemic (p = 0.004). Range of Motion at 6 weeks post operatively also varied significantly. Extension was significantly different (p = 0.003), as was flexion, (p = 0.014) by two-tailed student t-test.
DISCUSSION:
A significant number of post-operative transfusions were performed in patients found to be anaemic pre-operatively. We have identified that pre-operative anaemia is associated with two negative outcomes post operatively: Increased length of hospital stay and decreased final range of movement. There is a clear indication for a standardized approach for the detection and treatment of anaemia in preparation for elective total knee arthroplasty.
