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Does Preoperative Hemoglobin Value Predict Postoperative Cardiovascular Complications after Total Joint Arthroplasty?. Kishor Gandhi MD, MPH, Eugene Viscusi MD, Luis Pulido MD, and Javad Parvizi, MD. Introduction:. Anemia defined by the World Health Organization (WHO) 1 :
Kishor Gandhi MD, MPH, Eugene Viscusi MD, Luis Pulido MD, and Javad Parvizi, MD
1. WHO. Technical Report Series No. 405, Geneva, Switzerland: WHO.1968.
2. Penninx et al. Journal of Gerontology. 2006. Vol. 61A. 474-479.
3. Wu et al. JAMA. 2007; 297: 2481-2488.
4. Karkouti et al. Circulation 2008;117;478-484.
Examine the association between preoperative hemoglobin levels and cardiovascular complications in patients undergoing total hip and knee replacements.
1. Less than 12 g/dl (anemia group)
2. 12-14 g/dl (normal reference group)
3. Greater than 14 g/dl (above normal group)
Angina, arrhythmias, bradycardia, asystole, CHF, myocardial Infarctions, compartment syndrome, DVT’s, hypertension, hypotension, hypovolemic shock, and vascular injuries
Age, BMI, race, gender, O.R. time, joint type (hips vs. knees), number of joints (unilateral vs. bilateral), DM, HTN, cardiac history (CAD, arrhythmia, CHF, valvular disorder), PVD, DVT, and previous placement of Greenfield filter.
ØIn this analysis, 742 patients had preoperative anemia, 1914 patients with hemoglobin levels in the reference range, and 1298 patients in the above normal group (Table 1).
ØAverage age of patients were 65.9 (Hgb<12), 65.5 (reference group), and 60.7 years (Hgb>14).
ØThe anemia group had longer average length of surgery (128.3 minutes), compared to the reference and above normal groups (114.3 and 116.1 minutes, respectively).
ØA higher percentage of patients with preoperative anemia had a history of CAD (16.8%), CHF (3.6%), arrhythmias (7%), and valvular disorders (11%).
Ø Increased occurrence of comorbid hypertension (59.6%), diabetes (3.6%), peripheral vascular disease (1.7%), and DVT’s (3.6%) were also noted in this group.
ØBivariate analyses indicated that patients with preoperative anemia have greater cardiovascular complications (Table 2).
ØDue to significant differences in potential confounders between the three groups’ bivariate analyses, they were controlled for in logistic regression models (Table 3).
ØLogistic regression model showed that patients with preoperative anemia (Hgb<12) have statistically significant risk of cardiovascular complications (Odds Ratio=1.778, p<0.05).
ØIn this retrospective analysis, anemic patients (those identified with lower preoperative hemoglobin values) have an increased risk of cardiovascular complications.
ØPreoperative hemoglobin levels may be predictive of postoperative cardiovascular complications.
ØThese patients may benefit from more than just reversal of anemia preoperatively, rather increased surveillance for postoperative complications.