Risk Factors Of Perioperative Blood Transfusion In Total Hip Arthroplasty For Crowe Type Ⅱ And Ⅲ DDH

Purpose: In the final stage of adult hip dysplasia,it is easy to form hip osteoarthritis,and finally needs total hip arthroplasty.Total hip arthroplasty with dysplasia of the hip has a high perioperative blood loss and a high perioperative blood transfusion rate.Understanding the risk factors of perioperative blood transfusion,and preventing and managing them can effectively reduce the perioperative blood transfusion rate and reduce the potential complications of blood transfusion,including allergic reactions,fever and infectious diseases.The purpose of this study is to find out the risk factors of perioperative blood transfusion in patients with Crowe type II and Crowe type III hip dysplasia undergoing total hip arthroplasty,so as to improve and update the knowledge system of perioperative blood transfusion in total hip arthroplasty and bring optimal treatment decisions to patients.Methods: The clinical data of Crowe type II and Crowe type III hip dysplasia patients who underwent total hip arthroplasty in the Department of adult orthopaedics,Shengjing Hospital of China Medical University from January 1,2015 to January 1,2022 were retrospectively collected.According to previous research results,clinical experience and characteristic indicators of DDH patients constitute important risk factor variables potentially affecting perioperative blood transfusion,including age,sex,weight,whether you have hypertension,whether you have diabetes,anesthesia mode,whether you use tranexamic acid during operation,operation duration,surgeon,Crowe classification,use of S-ROM prosthesis,drainage volume on the first day after operation,length of stay Preoperative hemoglobin level,preoperative mean red blood cell volume,preoperative serum albumin level,preoperative platelet count,preoperative blood creatinine,preoperative blood uric acid,preoperative prothrombin time,preoperative activated partial thromboplastin time and preoperative fibrinogen content.The risk factors of perioperative blood transfusion were observed by univariate analysis,multivariate logistic regression analysis and stratified analysis.We tried to establish a blood transfusion prediction model by building a nomogram model and evaluating its efficacy.Results: A total of 81 patients with Crowe type II and Crowe type III hip dysplasia who underwent total hip arthroplasty were included in this study.The perioperative blood transfusion rate was 39.5%.In patients with Crowe II and Crowe III hip dysplasia undergoing total hip arthroplasty,the perioperative operation time of the blood transfusion group was longer than that of the non transfusion group(median 172.5minutes vs 148.0 minutes),the preoperative serum albumin of the blood transfusion group was lower than that of the non transfusion group(mean 42.3 g/L vs 40.5 g/L),and the preoperative average erythrocyte volume of the blood transfusion group tended to be higher than that of the non transfusion group(P = 0.053).However,there was no significant difference in age,sex,weight,hypertension,diabetes,Crowe classification,anesthesia mode,use of tranexamic acid during operation,surgeon,use of S-ROM prosthesis,drainage volume on the first day after operation,length of stay,preoperative hemoglobin level,preoperative platelet count,preoperative blood creatinine,preoperative blood uric acid,preoperative coagulation index between the transfusion group and the non transfusion group.The results of multivariate analysis suggested that the duration of operation and preoperative serum albumin level were independent risk factors for perioperative blood transfusion in patients with Crowe Ⅱ and Crowe Ⅲ hip dysplasia undergoing unilateral total hip replacement.At the same time,the results of stratified analysis suggest that the preoperative average erythrocyte volume is a risk factor for perioperative blood transfusion in potential female patients with Crowe Ⅱ and CroweⅢ hip dysplasia undergoing unilateral total hip replacement.In female Crowe II and III hip dysplasia patients,the area under the ROC curve(AUC)of the nomogram prediction model for perioperative blood transfusion in unilateral total hip arthroplasty established according to the duration of operation,the average preoperative red blood cell volume and the preoperative serum albumin level is 0.717.The original curve and the corrected curve of the calibration map do not converge with the slope of the ideal curve.Conclusion: Operation duration and preoperative serum albumin level are independent risk factors for perioperative blood transfusion in patients with Crowe Ⅱ and Crowe Ⅲhip dysplasia undergoing unilateral total hip replacement.At the same time,the preoperative mean red blood cell volume is a risk factor for perioperative blood transfusion in potential female patients with Crowe II and Crowe III hip dysplasia undergoing unilateral total hip arthroplasty.