Navendu Goyal1, Ritik Kaul2, Ian A Harris3, Darren B Chen4, Samuel J MacDessi5. 1. Sydney Knee Specialists, NSW, Australia. 2. Canterbury Hospital, NSW, Australia. 3. Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Australia. 4. St George Private Hospital, Sydney, NSW, Australia. 5. St George Private Hospital, Sydney, NSW, Australia. Electronic address: samuelmacdessi@sydneyknee.com.au.
Abstract
BACKGROUND: Total knee arthroplasty (TKA) can result in significant blood loss, leading to a need for blood transfusion. The major indication of transfusion is post-operative hemoglobin (Hb) levels in association with symptomatic anemia. The aim of this study was to determine the possibility of eliminating routine post-operative Hb tests in patients undergoing TKA with intra-articular tranexamic acid (TXA) use based on the predictability of pre-operative factors. METHODS: We conducted a retrospective analysis of 487 patients who underwent TKA with intra-articular TXA use. Statistical analysis was done to predict the transfusion risk based on multiple pre-operative parameters. RESULTS: Post-operative blood transfusions were required in 2.5% of all patients. Pre-operative-Hb was the only significant predictor of post-operative transfusion (p<0.0001). Age, sex, weight, height and body mass index (BMI) were not related to post-operative transfusion risk. Transfusions were needed in 4.2% of patients with pre-operative Hb levels <14 g/dl. No patient with a pre-operative Hb >14 g/dl required a transfusion (p<0.0001). CONCLUSIONS: Pre-operative Hb is a strong predictor of post-operative blood transfusion risk. Patients who receive TXA in TKA, with a pre-operative Hb >14 g/dl do not require routine post-operative Hb evaluation. LEVEL OF EVIDENCE: IV.
BACKGROUND:Total knee arthroplasty (TKA) can result in significant blood loss, leading to a need for blood transfusion. The major indication of transfusion is post-operative hemoglobin (Hb) levels in association with symptomatic anemia. The aim of this study was to determine the possibility of eliminating routine post-operative Hb tests in patients undergoing TKA with intra-articulartranexamic acid (TXA) use based on the predictability of pre-operative factors. METHODS: We conducted a retrospective analysis of 487 patients who underwent TKA with intra-articularTXA use. Statistical analysis was done to predict the transfusion risk based on multiple pre-operative parameters. RESULTS: Post-operative blood transfusions were required in 2.5% of all patients. Pre-operative-Hb was the only significant predictor of post-operative transfusion (p<0.0001). Age, sex, weight, height and body mass index (BMI) were not related to post-operative transfusion risk. Transfusions were needed in 4.2% of patients with pre-operative Hb levels <14 g/dl. No patient with a pre-operative Hb >14 g/dl required a transfusion (p<0.0001). CONCLUSIONS: Pre-operative Hb is a strong predictor of post-operative blood transfusion risk. Patients who receive TXA in TKA, with a pre-operative Hb >14 g/dl do not require routine post-operative Hb evaluation. LEVEL OF EVIDENCE: IV.
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