Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty
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 estima...
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| Format: | Journal Article |
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Wiley-Blackwell
2014
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| Online Access: | http://hdl.handle.net/20.500.11937/5866 |
| _version_ | 1848744915720208384 |
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| author | Graves, A. Yates, P. Hofmann, Axel Farmer, Shannon Ferrari, P. |
| author_facet | Graves, A. Yates, P. Hofmann, Axel Farmer, Shannon Ferrari, P. |
| author_sort | Graves, A. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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 under- going elective total knee or hip arthroplasty compared with 294 without CKD. Multivariate analyses for ABT risk with haemoglobin, eGFR, age, gender, duration of surgery and primary versus revision surgery were performed. Results: Patients with CKD had lower preoperative haemoglobin and higher incidence of ABT. Haemoglobin was independently associated with increased odds of ABT (0.74 (95% confidence interval 0.71–0.77), P = 0.001), but eGFR was not (0.98 (0.96–1.02), P = 0.089). Length-of-stay and 1 year mortality did not differ between non-transfused CKD patients and controls. Transfused CKD patients had significantly higher length-of-stay compared with transfused controls (25 ± 21 vs 19 ± 16 days, P<0.0001), although 1 year mortality between transfused CKD patients and controls did not differ significantly. Conclusion: CKD alone, in the absence of anaemia, does not predispose to increased risk of ABT or length-of-stay in patients with mild-to-moderate CKD undergoing elective joint surgery. However, low haemoglobin is associated with increased ABT utilization and increased length-of-stay. Considering that 1 in 4 patients undergoing elective hip or knee arthroplasty has CKD, optimal preoperative patient blood management may improve outcome in this population. |
| first_indexed | 2025-11-14T06:09:03Z |
| format | Journal Article |
| id | curtin-20.500.11937-5866 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T06:09:03Z |
| publishDate | 2014 |
| publisher | Wiley-Blackwell |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-58662017-09-13T14:42:52Z Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty Graves, A. Yates, P. Hofmann, Axel Farmer, Shannon Ferrari, P. complication anaemia joint arthroplasty transfusion chronic kidney disease 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 under- going elective total knee or hip arthroplasty compared with 294 without CKD. Multivariate analyses for ABT risk with haemoglobin, eGFR, age, gender, duration of surgery and primary versus revision surgery were performed. Results: Patients with CKD had lower preoperative haemoglobin and higher incidence of ABT. Haemoglobin was independently associated with increased odds of ABT (0.74 (95% confidence interval 0.71–0.77), P = 0.001), but eGFR was not (0.98 (0.96–1.02), P = 0.089). Length-of-stay and 1 year mortality did not differ between non-transfused CKD patients and controls. Transfused CKD patients had significantly higher length-of-stay compared with transfused controls (25 ± 21 vs 19 ± 16 days, P<0.0001), although 1 year mortality between transfused CKD patients and controls did not differ significantly. Conclusion: CKD alone, in the absence of anaemia, does not predispose to increased risk of ABT or length-of-stay in patients with mild-to-moderate CKD undergoing elective joint surgery. However, low haemoglobin is associated with increased ABT utilization and increased length-of-stay. Considering that 1 in 4 patients undergoing elective hip or knee arthroplasty has CKD, optimal preoperative patient blood management may improve outcome in this population. 2014 Journal Article http://hdl.handle.net/20.500.11937/5866 10.1111/nep.12239 Wiley-Blackwell restricted |
| spellingShingle | complication anaemia joint arthroplasty transfusion chronic kidney disease Graves, A. Yates, P. Hofmann, Axel Farmer, Shannon Ferrari, P. Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty |
| title | Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty |
| title_full | Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty |
| title_fullStr | Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty |
| title_full_unstemmed | Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty |
| title_short | Predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty |
| title_sort | predictors of perioperative blood transfusions in patients with chronic kidney disease undergoing elective knee and hip arthroplasty |
| topic | complication anaemia joint arthroplasty transfusion chronic kidney disease |
| url | http://hdl.handle.net/20.500.11937/5866 |