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Preoperative anaemia AND knee replacement AND hip replacement

Philippe Van der Linden, Jean-François Hardy
BACKGROUND: Preoperative anaemia is associated with increased postoperative morbidity and mortality. Patient blood management (PBM) is advocated to improve patient outcomes. OBJECTIVES: NATA, the 'Network for the advancement of patient blood management, haemostasis and thrombosis', initiated a benchmark project with the aim of providing the basis for educational strategies to implement optimal PBM in participating centres. DESIGN: Prospective, observational study with online data collection in 11 secondary and tertiary care institutions interested in developing PBM...
December 2016: European Journal of Anaesthesiology
R Kasivisvanathan, V Ramesh, R Rao Baikady, S Nadaraja
OBJECTIVES: To estimate the prevalence of preoperative World Health Organization (WHO) defined anaemia in patients presenting for revision hip and knee arthroplasty and its association with transfusion of allogeneic packed red blood cells (PRBC). BACKGROUND: Studies have mainly investigated the prevalence of preoperative anaemia in primary and not revision hip and knee joint arthroplasty. METHODS: An analysis of a prospectively collected patient data for 5387 patients having revision hip or knee arthroplasty over a 10-year period at a single high volume centre was conducted...
August 2016: Transfusion Medicine
N Frew, D Alexander, J Hood, A Acornley
Introduction Preoperative anaemia remains undertreated in the UK despite advice from national agencies to implement blood conservation measures. A local retrospective audit of 717 primary hip/knee replacements in 2008-2009 revealed 25% of patients were anaemic preoperatively. These patients experienced significantly increased transfusion requirements and length of stay. We report the results of a simple and pragmatic blood management protocol in a district general hospital. Methods Since 2010 patients at our institution who are found to be anaemic when listed for hip/knee replacement have been offered iron supplementation and/or erythropoietin depending on haemoglobin and ferritin levels...
July 2016: Annals of the Royal College of Surgeons of England
C C Jørgensen, Ø Jans, H Kehlet
BACKGROUND: Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered gastrointestinal (GI) cancer requiring further investigation. However, the association between preoperative anaemia and cancer 1 year after elective total hip (THA) and total knee arthroplasty (TKA) is unknown...
July 2015: Vox Sanguinis
Angela Graves, Piers Yates, Axel O Hofmann, Shannon Farmer, Paolo Ferrari
BACKGROUND: Lower preoperative haemoglobin and older age pose a risk for perioperative allogeneic blood transfusions (ABT). The presence of chronic kidney disease (CKD) is associated with low haemoglobin, greater bleeding and ABT utilization. STUDY DESIGN AND METHODS: The interaction between estimated glomerular filtration rate (eGFR) and haemoglobin on perioperative ABT, length-of-stay and mortality was assessed in 86 patients with CKD stage 3 or higher undergoing elective total knee or hip arthroplasty compared with 294 without CKD...
July 2014: Nephrology
Henrik Kehlet, Emmanuel Thienpont
BACKGROUND: Fast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee arthroplasty. METHOD: Both authors searched the contemporary literature on minimally invasive knee arthroplasty and review articles on fast-track surgery aiming to summarize recent developments...
September 2013: Knee
A Kotzé, L A Carter, A J Scally
BACKGROUND: There are few data on the associations between anaemia, allogeneic blood transfusion (ABT), patient blood management, and outcome after arthroplasty in the UK. National agencies nevertheless instruct NHS Trusts to implement blood conservation measures including preoperative anaemia management. Internationally, blood management programmes show encouraging results. METHODS: We retrospectively audited 717 primary hip or knee arthroplasties in a UK general hospital and conducted regression analyses to identify outcome predictors...
June 2012: British Journal of Anaesthesia
S Evans, E O'Loughlin, J Bruce
We retrospectively audited the incidence of blood transfusion and related this to preoperative haemoglobin levels in 181 patients undergoing lower limb arthroplasty over a six-month period. This included 102 primary total knee replacements, 52 primary total hip replacements, 11 revision total knee replacements and 16 revision total hip replacements. The overall incidence of transfusion was 16.0%. The incidence in primary arthroplasty was 11% (9.8% for total knee replacements and 13.5% for total hip replacements), and in revision surgery was 44...
May 2011: Anaesthesia and Intensive Care
E Saleh, D B L McClelland, A Hay, D Semple, T S Walsh
BACKGROUND: Preoperative investigation and treatment of anaemia is recommended before orthopaedic surgery. We measured the prevalence of anaemia among admissions presenting for elective major joint arthroplasty (MJA), assessed their transfusion requirements, and investigated factors associated with perioperative blood transfusion. METHODS: All admissions to a dedicated elective orthopaedic hospital during 2000-2001 were studied. The patients' database was merged with the haematology and transfusion databases...
December 2007: British Journal of Anaesthesia
M Basora, R Deulofeu, F Salazar, L Quinto, C Gomar
A poor preoperative haemoglobin (Hb) status is frequently encountered among adult patients scheduled for corrective surgery of the locomotive system, representing the main risk factor for blood transfusion. The soluble transferrin receptor (sTfR) has become a highly specific parameter for the detection of iron deficits as it can differentiate between iron deficiency anaemia and anaemia of chronic disease, because of the lack of effect by associated inflammation, unlike ferritin. The objectives of this study were to evaluate patients with the prevalence of risk for transfusion, the effect of inflammation on ferritin (F) values and functional iron deficiency in elderly patients with advanced degenerative arthropathy scheduled for hip or knee replacement...
December 2006: Clinical and Laboratory Haematology
M Grover, S Talwalkar, A Casbard, H Boralessa, M Contreras, H Boralessa, S Brett, D R Goldhill, N Soni
BACKGROUND AND OBJECTIVES: Red cell transfusion is commonly used in orthopaedic surgery. Evidence suggests that a restrictive transfusion strategy may be safe for most patients. However, concern has been raised over the risks of anaemia in those with ischaemic cardiac disease. Perioperative silent myocardial ischaemia (SMI) has a relatively high incidence in the elderly population undergoing elective surgery. This study used Holter monitoring to compare the effect of a restrictive and a liberal red cell transfusion strategy on the incidence of SMI in patients without signs or symptoms of ischaemic heart disease who were undergoing lower limb arthroplasty...
February 2006: Vox Sanguinis
P M Sutton, T Cresswell, J P Livesey, K Speed, T Bagga
After total hip and knee replacement arthroplasty, patients may become anaemic and may be prescribed oral iron. There is, however, no published evidence that this is of benefit when used postoperatively. We treated 72 patients who were anaemic after primary total hip and knee arthroplasty by randomly allocating them to receive six weeks of either oral ferrous sulphate (35 patients) or a placebo (37 patients). Both groups of patients were similar in all aspects except for the treatment given. There was no statistically significant difference in the change of haemoglobin levels between the two groups...
January 2004: Journal of Bone and Joint Surgery. British Volume
G Gandini, M Franchini, M de Gironcoli, A Giuffrida, D Bertuzzo, L Zanolla, I Ferro, D Regis, G Aprili
BACKGROUND AND OBJECTIVES: To assess the feasibility of a programme of predeposit in elderly patients undergoing elective orthopaedic surgery. PATIENTS AND METHODS: We retrospectively studied 789 elderly patient candidates (> 65 years of age) for orthopaedic surgery (total hip and knee replacement and spinal surgery), who were undergoing a programme of preoperative autologous blood donation (PABD) in our city hospital between January 1990 and December 1998. RESULTS: Six hundred and eighty-eight patients (87...
February 2001: Vox Sanguinis
B Borghi, A Casati
The efficacy of an integrated autotransfusion regimen, including pre-donation and perioperative salvage of autologous blood, was prospectively evaluated in 2884 patients undergoing total hip (n = 2016) or knee arthroplasty (n = 480), and hip revision (n = 388) with either balanced general, regional, or integrated epidural/general anaesthesia. Allogenic concentrated red blood cells were transfused in the presence of symptomatic anaemia or when haemoglobin concentration was < 6 g dL-1 (10 g dL-1 in patients affected by cerebrovascular or coronary artery disease) after all salvaged and pre-donated autologous blood had been transfused...
July 2000: European Journal of Anaesthesiology
C M Andrews, D W Lane, J G Bradley
Patients undergoing total hip or knee replacement frequently receive blood transfusion. Homologous blood transfusion carries appreciable risks and should therefore be reduced to a minimum. We have investigated the use of preoperative oral iron supplements to optimize haemoglobin concentration and iron stores prior to surgery. All patients attending a preadmission clinic 4 weeks prior to primary hip or knee replacement had a haemoglobin measurement. If the haemoglobin concentration (Hb) was less than 12 g dL-1 they were given a four week course of ferrous sulphate...
December 1997: Transfusion Medicine
A Quoss, S Paululat
The management and the resulting effectiveness of a four-step autotransfusion concept, consisting of preoperative autologous blood predeposit, isovolaemic haemodilution, preoperative plasmapheresis and intraoperative autotransfusion in rheumatic patients undergoing planned operations associated with considerable blood loss, are presented. In just one case out of 117 primary total joint replacements of the hip or knee that were retrospectively studied in rheumatic patients suffering from chronic anaemia did a homologous erythrocyte concentrate have to be transfused...
1997: Anaesthesiologie und Reanimation
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