Blood Management May Have an Impact on Length of Stay After Total Hip Arthroplasty

Overview

Journal HSS J

Date 2014 Jul 23

PMID 25050095

Citations 13

Authors

Jad Bou Monsef

Friedrich Boettner

Affiliations

Soon will be listed here.

Abstract

Background: The steady rise in demand for total hip arthroplasty constitutes a significant and increasing burden on health care resources. The biggest contributors to the total cost of hip replacement procedures other than the price of the implant are hospital stay and postoperative rehabilitation. Blood management is one of the most adjustable factors that can impact length of stay and cost-efficiency while improving patient safety.

Questions/purposes: The primary purpose of this retrospective study was to assess the potential impact of blood management interventions on length of hospital stay after primary unilateral total hip arthroplasty. This was achieved by first identifying which patient and surgical factors are associated with an increased risk of prolonged hospital stay. Subsequently, the significant factors were controlled for through a multivariate regression analysis to quantify the association between blood transfusions and increased hospital stay.

Methods: Retrospectively, the study included 2,104 primary total hip replacements. Eight hundred eighty-eight procedures were performed on males and 1,216 on females, with a mean age of 64 years at the time of the surgery (range 18-94 years) and BMI of 28.6 kg/m(2) (range 12-51.5 kg/m(2)). The correlation between each factor and length of stay was analyzed separately using univariate regression analysis. Those variables with p ≤ 0.05 in the univariate model were selected for inclusion in the multivariate logistic regressions. Multiple linear regression was used to analyze the effect of each significant factor and derive odds ratios with adjustment for the other variables.

Results: Multivariate Poisson regression revealed that increased length of stay was significantly correlated to patient age (p = 0.05), the use of coumadin (p = 0.02) or lovenox/heparin (p = 0.007) as opposed to aspirin for anticoagulation, and allogeneic blood transfusion (p < 0.0001). The data shows that allogeneic blood transfusion is associated with a longer hospital stay regardless of absolute drop in hemoglobin level postoperatively or at discharge or the number of units transfused (OR = 1.18, 95% CI = 1.09 to 1.28, p < 0.001).

Conclusion: Transfusion of allogeneic blood is independently associated with increased hospital stay after total hip arthroplasty. Blood management modalities that can significantly reduce transfusion risk could impact length of stay as well as the total cost of hip replacement procedures.

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References

Weber E, Slappendel R, Prins M, van der Schaaf D, Durieux M, Strumper D . Perioperative blood transfusions and delayed wound healing after hip replacement surgery: effects on duration of hospitalization. Anesth Analg. 2005; 100(5):1416-1421. DOI: 10.1213/01.ANE.0000150610.44631.9D. View

Bozic K, Wagie A, Naessens J, Berry D, Rubash H . Predictors of discharge to an inpatient extended care facility after total hip or knee arthroplasty. J Arthroplasty. 2006; 21(6 Suppl 2):151-6. DOI: 10.1016/j.arth.2006.04.015. View

Larsen K, Sorensen O, Hansen T, Thomsen P, Soballe K . Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop. 2008; 79(2):149-59. DOI: 10.1080/17453670710014923. View

Jans O, Jorgensen C, Kehlet H, Johansson P . Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty. Transfusion. 2013; 54(3):717-26. DOI: 10.1111/trf.12332. View

Tahim A, Stokes O, Vedi V . The effect of femoral stem length on duration of hospital stay. Hip Int. 2012; 22(1):56-61. DOI: 10.5301/HIP.2012.9035. View

Husted H, Hansen H, Holm G, Bach-Dal C, Rud K, Andersen K . What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg. 2009; 130(2):263-8. DOI: 10.1007/s00402-009-0940-7. View

Dall G, Ohly N, Ballantyne J, Brenkel I . The influence of pre-operative factors on the length of in-patient stay following primary total hip replacement for osteoarthritis: a multivariate analysis of 2302 patients. J Bone Joint Surg Br. 2009; 91(4):434-40. DOI: 10.1302/0301-620X.91B4.21505. View

Sigurdsson E, Siggeirsdottir K, Jonsson Jr H, Gudnason V, Matthiasson T, Jonsson B . Early discharge and home intervention reduces unit costs after total hip replacement: results of a cost analysis in a randomized study. Int J Health Care Finance Econ. 2008; 8(3):181-92. DOI: 10.1007/s10754-008-9036-0. View

Friedman R, Homering M, Holberg G, Berkowitz S . Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty. J Bone Joint Surg Am. 2014; 96(4):272-8. DOI: 10.2106/JBJS.L.01268. View

10.

Kotze A, Carter L, Scally A . Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle. Br J Anaesth. 2012; 108(6):943-52. DOI: 10.1093/bja/aes135. View

11.

Guerin S, Collins C, Kapoor H, McClean I, Collins D . Blood transfusion requirement prediction in patients undergoing primary total hip and knee arthroplasty. Transfus Med. 2007; 17(1):37-43. DOI: 10.1111/j.1365-3148.2006.00698.x. View

12.

Baumgartner J, Silliman C, Moore E, Banerjee A, McCarter M . Stored red blood cell transfusion induces regulatory T cells. J Am Coll Surg. 2009; 208(1):110-9. PMC: 5787354. DOI: 10.1016/j.jamcollsurg.2008.08.012. View

13.

Dawson-Bowling S, Jha S, Chettiar K, East D, Gould G, Apthorp H . A multidisciplinary enhanced recovery programme allows discharge within two days of total hip replacement; three- to five-year results of 100 patients. Hip Int. 2014; 24(2):167-74. DOI: 10.5301/hipint.5000100. View

14.

Martin C, Pugely A, Gao Y, Clark C . A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty. 2013; 28(5):849-54. DOI: 10.1016/j.arth.2012.10.029. View

15.

Martinez V, Monsaingeon-Lion A, Cherif K, Judet T, Chauvin M, Fletcher D . Transfusion strategy for primary knee and hip arthroplasty: impact of an algorithm to lower transfusion rates and hospital costs. Br J Anaesth. 2007; 99(6):794-800. DOI: 10.1093/bja/aem266. View

16.

Newman E, Watters T, Lewis J, Jennings J, Wellman S, Attarian D . Impact of perioperative allogeneic and autologous blood transfusion on acute wound infection following total knee and total hip arthroplasty. J Bone Joint Surg Am. 2014; 96(4):279-84. DOI: 10.2106/JBJS.L.01041. View

17.

Borghi B, Casati A . Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen. The Rizzoli Study Group on Orthopaedic Anaesthesia. Eur J Anaesthesiol. 2000; 17(7):411-7. DOI: 10.1046/j.1365-2346.2000.00693.x. View

18.

Husted H, Hansen H, Holm G, Bach-Dal C, Rud K, Andersen K . [Length of stay in total hip and knee arthroplasty in Danmark I: volume, morbidity, mortality and resource utilization. A national survey in orthopaedic departments in Denmark]. Ugeskr Laeger. 2006; 168(22):2139-43. View

19.

Oldmeadow L, McBurney H, Robertson V . Predicting risk of extended inpatient rehabilitation after hip or knee arthroplasty. J Arthroplasty. 2003; 18(6):775-9. DOI: 10.1016/s0883-5403(03)00151-7. View

20.

Bierbaum B, Callaghan J, Galante J, Rubash H, TOOMS R, Welch R . An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am. 1999; 81(1):2-10. DOI: 10.2106/00004623-199901000-00002. View