Analysis Of High Hidden Blood Loss And Its Influential Factors After Primary Unilateral Total Kip Arthroplasty

Objective:To explore the related factors of high Hidden Blood Loss(HBL)after Total Knee Arthroplasty(TKA),and to further clarify the risk factors and protective factors that lead to HBL,so as to form a reasonable TKA diagnosis and treatment plan and guide perioperative blood management system with scientific evaluation methodsMethods:A retrospective analysis of 302 patients who were treated with TKA at Lanzhou University First Hospital from January 2017 to January 2020 and met the inclusion and exclusion criteria of this study.Univariate analysis and unconditional multivariate logistic regression analysis to study the related factors of perioperative high HBL after TKA.The statistical indexes included gender,age,body mass index(BMI),history of smoking,history of drinking,hyperlipidemia,hypertension,diabetes,history of cardiovascular disease,chronic obstructive pulmonary disease(COPD),osteoporosis(OP),American Society of Anesthesiologists(ASA)classification,type of primary disease,surgical side,type of malformation,anesthesia method,operation duration,tourniquet use duration,tranexamic acid(TXA),adrenaline,matching condition of knee joint and prosthesis,position of surgical limb position,ice compress,postoperative anticoagulant selection,postoperative walking time,deep venous thrombosis(DVT)complications,preoperative and postoperative platelet(PLT),preoperative and postoperative red blood cell(RBC),preoperative and postoperative hemoglobin(HGB),preoperative and postoperative hematocrit(HCT),preoperative blood volume,intraoperative blood loss volume,postoperative drainage volume and total blood loss volume,a total of 38 factors that may be related to perioperative high HBL in TKA were included in this study.Results:A total of 302 patients with TKA were included in this study.There were 126 cases(41.7%)with low HBL and 176 cases(58.3%)with high HBL.The univariate analysis results showed that 15 factors could increase the incidence of high HBL after TKA,and the difference was statistically significant(p<0.05),respectively:elderly(t=-2.123,p=0.035),obesity(t=-6.568,p=0.000),diabetes(?2=7.945,p=0.005),OP(?2=8.041,p=0.005),general anesthesia(?2=9.239,p=0.002),operation duration>90min(?2=15.004,p=0.000),the use of tourniquet throughout the operation(?2=9.471,p=0.002),mismatch between prosthesis and knee joint(?2=4.034,p=0.045),postoperative PLT(t=4.620,p=0.000),postoperative RBC(t=7.117,p=0.000),postoperative HGB(t=0.617,p=0.000),postoperative HCT(t=6.965,p=0.000),high intraoperative blood loss(t=-5.442,p=0.000),high drainage(t=-4.606,p=0.000),high total blood loss(t=-18.633,p=0.000);4 factors could reduce the amount of high HBL after TKA,the difference was statistically significant(p<0.05),respectively:the use of TXA(?2=8.041,p=0.005),the use of adrenaline(?2=8.372,p=0.004),postoperative surgical limb flexion(?2=6.417,p=0.011),ice compress(?2=7.084,p=0.008);the remaining 19 factors statistical results were not statistically significant(p>0.05).Multi-factor non-conditional logistic regression analysis through the above-mentioned significant influencing factors on high HBL showed that:The 6 factors of the regression coefficients(?)>0,the odds ratio(OR)>1,and the difference was statistically significant(p<0.05),respectively:elderly(?=0.5,OR=1.051,p=0.014),obesity(?=0.257,OR=1.293,p=0.000),OP(?=1.067,OR=2.906,p=0.018),general anesthesia(?=1.058,OR=2.881,p=0.019),operation duration>90min(?=0.951,OR=2.589,p=0.003),the use of tourniquets throughout the operation(?=0.928,OR=2.529,p=0.008);1 factor ?<0,OR<1,and the difference was statistically significant(p<0.05):the use of tranexamic acid during operation(?=-0.869,OR=0.419,p=0.006);there was no significant difference in the other factors(p>0.05).Conclusions:(1)elderly,obesity,diabetes,OP,general anesthesia,operation duration>90min,the use of tourniquets throughout the operation,mismatch between prosthesis and knee joint,postoperative low PLT,postoperative low RBC,postoperative low HGB,postoperative low HCT,postoperative high blood loss,postoperative high drainage,high total blood loss,a total of 15 factors were important risk factors for high HBL after TKA;TXA,adrenaline,postoperative surgical limb flexion and surgical limb,ice compress were a total of 4 factors that were important protective factors for high HBL after TKA.(2)elderly,obesity,OP,general anesthesia,operation duration>90min,and the use of tourniquets throughout the operation,a total of 6 factors were independent risk factors for high HBL after TKA;the use of TXA was an independent protective factor for high HBL after TKA.