| Background and objectiveTotal knee arthroplasty is an effective method for the treatment of end-stage osteoarthritis or rheumatoid arthritis.Total knee arthroplasty aims to correct lower limb deformity,relieve knee pain and improve knee range of motion by removing the damaged knee joint surface and replacing with the artificial joint prosthesis made of special materials.Currently,about 2 million patients worldwide were treated by total knee arthroplasty each year.In China,the number of patients receiving total knee replacement has been increasing year by year with the acceleration of population aging,the increase of obesity,and the improvement of medical level,and it is expected to reach about 800,000 in 2025.Although total knee arthroplasty brings a lot of benefits to the society and patients,the high rate of allogeneic blood transfusion after total knee arthroplasty is still a major clinical problem.Due to extensive soft tissue exposure,loosening,and extensive bone resection during surgery,patients usually lose a lot of blood during perioperative period.About 18%to 67%of patients require allogeneic blood transfusion after total knee replacement to reduce the harm of anaemia and accelerate the recovery process.However,allogeneic blood transfusion may also bring a variety of complications,including hemolysis reaction,allergic reaction,periprosthetic joint infection,the transmission of blood-borne diseases such as Hepatitis and HIV etc.And expensive costs of blood transfusion will also increase the economic burden of patients.At the same time,there is a shortage of blood resources in Chinese blood banks.In recent years,the increasing number of recipients of allogeneic blood transfusions makes the contradiction between blood supply and demand increasingly prominent.At present,it has become an important topic in clinical research of bone and joint surgery that how to reduce the rate of allogeneic blood transfusion after total knee arthroplasty.In this study,687 patients treated with total knee arthroplasty in our hospital were selected.We conducted a retrospective analysis of related factors that may affect patients with allogeneic blood transfusion after surgery,and screened out the independent risk factors,in order to provide a reference for reducing the rate of allogeneic blood transfusion after total knee replacement.MethodsA retrospective analysis was conducted on 687 patients who were treated with total knee arthroplasty in the orthopedic surgery department of the First Affiliated Hospital of Zhengzhou University from January 2014 to May 2018,ranging in age from 35 to 89 years old,with an average age of 65.9 years.Patients were divided into two groups:allogeneic blood transfusion group and non allogeneic blood transfusion group according to whether they received allogeneic blood transfusion after total knee arthroplasty.A total of 197 patients in the allogeneic blood transfusion group received allogeneic blood transfusion after surgery,including 31 males and 166 females,with an average age of(67.99±7.34)years old.None of the 490 patients in the non allogeneic blood transfusion group received allogeneic blood transfusion after surgery,including 147 males and 343 females,with an average age of(65.12±7.80)years old.We record the relevant factors that may affect the allogeneic blood transfusion rate after total knee arthroplasty,including:age,gender,preoperative diagnosis(osteoarthritis/rheumatoid arthritis),preoperative complications(hypertension,diabetes,coronary heart disease),body mass index,American Society ofAnesthesiologists classification,preoperative hemoglobin,preoperative hematocrit,preoperative platelets,preoperative prothrombin time,preoperative activated part thrombin time,preoperative international normalized ratio,operation time,the choice of unilateral or bilateral total knee replacement,whether or not placing drainage tube after operation,etc.Statistical analysis of the data was performed by using SPSS 19.0 statistical software.Measured data with normal distribution were expressed as the mean±standard deviation(X±S).The data between the two groups were compared with independent samples t-test.The counting data were compared with chi-square test For the factors with statisticallysignificant differences obtained by univariate analysis,logistic regression analysis was used to screen for risk factors for allogeneic blood transfusion after total knee arthroplasty.P<0.05 is considered statistically significant.ResultsIn univariate analysis,there were 11 parameters with no significant difference between the two groups,including preoperative complications(hypertension,diabetes,coronary heart disease),body mass index,American Society of Anesthesiologists classification,preoperative platelets,preoperative prothrombin time,preoperative activated part thrombin time,preoperative international normalized ratio,operation time,the choice of unilateral or bilateral total knee replacement(P>0.05);And 6 parameters shown statistically significant differences between the two groups,including age,gender,preoperative diagnosis(osteoarthritis/rheumatoid arthritis),preoperative hemoglobin,preoperative hematocrit,whether or not placing drainage tube after operation(P<0.05);In multiple regression analysis,there are 5 parameters which shown statistically significant differences between the two groups,including age,gender,preoperative hemoglobin,preoperative hematocrit,whether or not placing drainage tube after operation(P<0.05);ConclusionAge,gender,preoperative hemoglobin,preoperative hematocrit,and whether or not placing drainage tube after surgery were independent risk factors affecting the rate of allogeneic blood transfusion after total knee replacement.It can help us predict patients' postoperative allogeneic need for blood transfusion by evaluation of the above factors.And blood protection measures should be actively taken during the perioperative period to prevent and reduce the occurrence of postoperative anemia and reduce the rate of allogeneic blood transfusion after total knee replacement for elderly patients,female patients,patients with preoperative anemia or drainage tube placement... |
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