BACKGROUND: Clinicians have adopted a restrictive transfusion threshold (75-80 g/L) after major orthopedic surgery. Anemia may be associated with a decrease in postoperative vigor. We hypothesize that, in these patients, a threshold hemoglobin (Hb) concentration exists below which functional recovery and quality of life (QoL) become difficult. STUDY DESIGN AND METHODS: A prospective, observational cohort study in 305 patients 60 years or older undergoing a total hip or knee arthroplasty was conducted. Major outcome variables were distance walked in 6 minutes (6MWT), score on the Borg Scale for perception of effort, maximal dominant hand strength, and Short Form 36 (SF-36) QoL assessment in the preoperative and early postoperative periods. Patients were categorized according to their Hb level the day of the postoperative 6MWT (≤ 80, 81-90, 91-100, and >100 g/L). RESULTS: There was no difference between Hb groups in the decrease of the distance walked preoperatively versus postoperatively. For both moments of observation, the 6MWT was not significantly different between Hb groups (p = 0.190). Similar results were found with perception of effort, maximal dominant hand strength, and SF-36 QoL assessment scores. In a regression model, the decrease in Hb concentration could explain only 1.9% of the total variation observed in the 6MWT (p = 0.008). CONCLUSION: Moderate anemia is not associated with an impaired functional recovery or QoL in the immediate postoperative period after major arthroplasties. Further studies will be required to determine the long-term consequences of a restrictive transfusion strategy in these patients.
BACKGROUND: Clinicians have adopted a restrictive transfusion threshold (75-80 g/L) after major orthopedic surgery. Anemia may be associated with a decrease in postoperative vigor. We hypothesize that, in these patients, a threshold hemoglobin (Hb) concentration exists below which functional recovery and quality of life (QoL) become difficult. STUDY DESIGN AND METHODS: A prospective, observational cohort study in 305 patients 60 years or older undergoing a total hip or knee arthroplasty was conducted. Major outcome variables were distance walked in 6 minutes (6MWT), score on the Borg Scale for perception of effort, maximal dominant hand strength, and Short Form 36 (SF-36) QoL assessment in the preoperative and early postoperative periods. Patients were categorized according to their Hb level the day of the postoperative 6MWT (≤ 80, 81-90, 91-100, and >100 g/L). RESULTS: There was no difference between Hb groups in the decrease of the distance walked preoperatively versus postoperatively. For both moments of observation, the 6MWT was not significantly different between Hb groups (p = 0.190). Similar results were found with perception of effort, maximal dominant hand strength, and SF-36 QoL assessment scores. In a regression model, the decrease in Hb concentration could explain only 1.9% of the total variation observed in the 6MWT (p = 0.008). CONCLUSION: Moderate anemia is not associated with an impaired functional recovery or QoL in the immediate postoperative period after major arthroplasties. Further studies will be required to determine the long-term consequences of a restrictive transfusion strategy in these patients.
Authors: Wieger G Horstmann; Martzen J Swierstra; David Ohanis; Rob Rolink; Boudewijn J Kollen; Cees C P M Verheyen Journal: Int Orthop Date: 2014-01 Impact factor: 3.075
Authors: Elizabeth St Lezin; Matthew S Karafin; Roberta Bruhn; Dhuly Chowdhury; Lirong Qu; Walter Bialkowski; Scott Merenda; Pamela D'Andrea; Anne-Lyne McCalla; Lisa Anderson; Sheila M Keating; Mars Stone; Edward L Snyder; Donald Brambilla; Edward L Murphy; Philip J Norris; Joan F Hilton; Bryan R Spencer; Steven Kleinman; Jeffrey L Carson Journal: Transfusion Date: 2019-03-18 Impact factor: 3.157
Authors: Cynthia So-Osman; Rob Nelissen; Ronald Brand; Frank Faber; Ron Te Slaa; Anne Stiggelbout; Anneke Brand Journal: Blood Transfus Date: 2013-02-06 Impact factor: 3.443
Authors: Wieger G Horstmann; Bart M Kuipers; Rob Slappendel; Rene M Castelein; Boudewijn J Kollen; Cees C P M Verheyen Journal: Int Orthop Date: 2012-07-13 Impact factor: 3.075
Authors: Hairil Rizal Abdullah; Niresh Ranjakunalan; William Yeo; Mann Hong Tan; Ruban Poopalalingam; Yilin Eileen Sim Journal: Qual Life Res Date: 2018-09-10 Impact factor: 4.147