Is Routine Hemoglobin Monitoring Necessary After Elective Hip and Knee Arthroplasty?

Overview

Journal Arthroplast Today

Publisher Elsevier

Date 2020 Sep 28

PMID 32984488

Citations 4

Authors

Orla Hennessy

Kevin McSorley

Affiliations

Soon will be listed here.

Abstract

Background: Many orthopaedic units measure hemoglobin (Hb) levels after primary joint arthroplasty to identify patients with postoperative anemia. With the refinement of surgical techniques, blood loss in primary arthroplasty has decreased. The aim of this study was to investigate the postoperative Hb monitoring and transfusion practices in our own institution after elective hip or knee arthroplasty.

Methods: We conducted a retrospective audit of all patients who underwent elective total hip or knee arthroplasty in Galway University Hospital between March 1 and June 1, 2019. We recorded when they underwent postoperative Hb testing, whether or not they had a drop of Hb, which would indicate transfusion (<8 g/dL), and whether or not they were transfused. In patients who underwent transfusion, a chart review was performed to establish the presence of factors that would have triggered repeat Hb testing.

Results: One hundred thirty-six patients underwent elective primary hip or knee arthroplasty in the period. All had a full blood count sent on the first postoperative day. None (0%) had a clinically significant (to < 8g/dL) postoperative Hb drop on day 1. Eighteen (13.2%) patients underwent repeat testing on day 2 or subsequently. Eight (5.9%) exhibited a drop in Hb to less than 8 g/dL, with a mean Hb drop of 4.26 (standard error of the mean ± 0.862, standard deviation ± 0.98), and 5 (3.7%) proceeded to undergo allogenic blood product transfusion. All 5 underwent documented indications for repeat Hb testing.

Conclusions: There is no evidence for performing routine Hb testing on day 1 after elective hip or knee arthroplasty. We recommend that postoperative Hb testing should only be carried out on patients with additional indications.

Citing Articles

Re-evaluating the Need of Postoperative Blood Testing in Low-Risk Patients After Primary Elective Arthroplasty: A Single-Centre Retrospective Analysis.

Johnson R, Samra I, Keshava N, Yadav A, Merchant J, Thakker V Cureus. 2024; 16(12):e76364.

PMID: 39726864 PMC: 11669605. DOI: 10.7759/cureus.76364.

Postoperative laboratory testing in the era of outpatient total joint arthroplasty: Targeted patient selection and associated cost savings.

Porto J, Lavu M, Hecht 2nd C, Guyler M, Acuna A, Kamath A J Orthop. 2024; 60:1-9.

PMID: 39345685 PMC: 11437600. DOI: 10.1016/j.jor.2024.09.012.

Are Routine Postoperative Hemoglobin Tests Justified in All Patients Who Undergo Total Hip Arthroplasty Due to a Displaced Femoral Neck Fracture?.

Gur S, Segal D, Tavdi A, Fuchs Y, Perl D, Fainzack A J Clin Med. 2024; 13(15).

PMID: 39124638 PMC: 11313077. DOI: 10.3390/jcm13154371.

Are Risk Factors for Postoperative Significant Hemorrhage following Total Knee Arthroplasty Potentially Modifiable? A Retrospective Cohort Study.

Wu E, Hung K, Juang S, Chin J, Lu H, Ko J J Pers Med. 2022; 12(3).

PMID: 35330434 PMC: 8949285. DOI: 10.3390/jpm12030434.

References

Sephton B, Edwards T, Bakhshayesh P, Nathwani D . Should we routinely perform a post-operative hemoglobin check following unicompartmental knee arthroplasty?. Knee. 2020; 27(1):249-256. DOI: 10.1016/j.knee.2019.10.002. View

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

Slover J, Lavery J, Schwarzkopf R, Iorio R, Bosco J, Gold H . Incidence and Risk Factors for Blood Transfusion in Total Joint Arthroplasty: Analysis of a Statewide Database. J Arthroplasty. 2017; 32(9):2684-2687.e1. DOI: 10.1016/j.arth.2017.04.048. View

Salido J, Marin L, Gomez L, Zorrilla P, Martinez C . Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors. J Bone Joint Surg Am. 2002; 84(2):216-20. DOI: 10.2106/00004623-200202000-00008. View

Yeh J, Chen J, Bin Abd Razak H, Loh B, Hao Y, Yew A . Preoperative haemoglobin cut-off values for the prediction of post-operative transfusion in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016; 24(10):3293-3298. DOI: 10.1007/s00167-016-4183-1. View

Pinzon-Florez C, Velez Canas K, Diaz Quijano D . Efficiency of tranexamic acid in perioperative blood loss in hip arthroplasty: a systematic literature review and meta-analysis. Rev Esp Anestesiol Reanim. 2014; 62(5):253-64. DOI: 10.1016/j.redar.2014.10.002. View

To J, Sinha R, Kim S, Robinson K, Kearney B, Howie D . Predicting Perioperative Transfusion in Elective Hip and Knee Arthroplasty: A Validated Predictive Model. Anesthesiology. 2017; 127(2):317-325. DOI: 10.1097/ALN.0000000000001709. View

Goyal N, Kaul R, Harris I, Chen D, MacDessi S . Is there a need for routine post-operative hemoglobin level estimation in total knee arthroplasty with tranexamic acid use?. Knee. 2016; 23(2):310-3. DOI: 10.1016/j.knee.2015.08.016. View

Silliman C, Boshkov L, Mehdizadehkashi Z, Elzi D, Dickey W, Podlosky L . Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. Blood. 2002; 101(2):454-62. DOI: 10.1182/blood-2002-03-0958. View

10.

Rohde J, Dimcheff D, Blumberg N, Saint S, Langa K, Kuhn L . Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA. 2014; 311(13):1317-26. PMC: 4289152. DOI: 10.1001/jama.2014.2726. View

11.

Tai T, Lin C, Jou I, Chang C, Lai K, Yang C . Tourniquet use in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2010; 19(7):1121-30. PMC: 3116117. DOI: 10.1007/s00167-010-1342-7. View

12.

Rosencher N, Kerkkamp H, Macheras G, Munuera L, Menichella G, Barton D . Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003; 43(4):459-69. DOI: 10.1046/j.1537-2995.2003.00348.x. View

13.

Lyu H, Xu T, Brotman D, Mayer-Blackwell B, Cooper M, Daniel M . Overtreatment in the United States. PLoS One. 2017; 12(9):e0181970. PMC: 5587107. DOI: 10.1371/journal.pone.0181970. View

14.

Boutsiadis A, Reynolds R, Saffarini M, Panisset J . Factors that influence blood loss and need for transfusion following total knee arthroplasty. Ann Transl Med. 2017; 5(21):418. PMC: 5690977. DOI: 10.21037/atm.2017.08.11. View

15.

Hart A, Abou Khalil J, Carli A, Huk O, Zukor D, Antoniou J . Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am. 2014; 96(23):1945-51. DOI: 10.2106/JBJS.N.00077. View

16.

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

17.

Steele H, Goetzl L . The practical utility of routine postpartum hemoglobin assessment. Am J Obstet Gynecol. 2014; 210(6):576.e1-6. DOI: 10.1016/j.ajog.2014.02.022. View

18.

Bini S, Darbinian J, Brox W, Khatod M . Risk Factors for Reaching the Post-Operative Transfusion Trigger in a Community Primary Total Knee Arthroplasty Population. J Arthroplasty. 2017; 33(3):711-717. DOI: 10.1016/j.arth.2017.10.029. View

19.

Kildow B, Howell E, Karas V, Baumgartner W, Cunningham D, Green C . When Should Complete Blood Count Tests Be Performed in Primary Total Hip Arthroplasty Patients?. J Arthroplasty. 2018; 33(10):3211-3214. DOI: 10.1016/j.arth.2018.05.030. View

20.

Carling M, Jeppsson A, Eriksson B, Brisby H . Transfusions and blood loss in total hip and knee arthroplasty: a prospective observational study. J Orthop Surg Res. 2015; 10:48. PMC: 4383080. DOI: 10.1186/s13018-015-0188-6. View