{"title":"Anemia Severity and the Risks of Postoperative Complications Following Total Ankle Arthroplasty.","authors":"Adam M Gordon, Azeem Tariq Malik","doi":"10.1177/19386400221106650","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Although studies have demonstrated the effect of anemia severity on postoperative complications after arthroplasties of the shoulder, hip, and knee, no studies have investigated the effect on total ankle arthroplasty (TAA). The objective was to determine the influence of preoperative anemia severity on complications following TAA.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried from 2006 to 2019 for patients undergoing TAA. Utilizing the World Health Organization (WHO) definitions of anemia, patients were stratified into 3 cohorts: nonanemia (hematocrit >36% for women, >39% for men), mild anemia (hematocrit 33%-36% for women, 33%-39% for men), and moderate to severe anemia (hematocrit <33% for both women and men). Demographics, comorbidities, length of stay, and short-term (30-day) postoperative complications were compared between groups. Bivariate analyses, including χ<sup>2</sup> and analysis of variance, and multivariable logistical regression were performed.</p><p><strong>Results: </strong>After exclusion, 1490 patients (1313 nonanemia [88.1%], 154 mild anemia [10.3%], and 23 moderate/severe anemia [1.6%]) were included. Increasing severity of anemia was associated with an increased average hospital length of stay (1.84 vs 2.19 vs 2.78 days, P < .001) and rate of reoperation (0.38% vs 3.90% vs 4.35%, P < .001). There was a statistically significant increase in wound disruptions (0.15% vs 1.95% vs 4.35%, P = .001), minor complications (1.52% vs 4.55% vs 8.70%, P = .008), major complications (1.98% vs 5.84% vs 4.35%, P < .033), and any complications (3.50% vs 10.39% vs 13.04%, P = .001) between groups. Multivariate analysis identified mild and moderate/severe anemia as a predictor of reoperation and extended length of stay (P ≤ .033).</p><p><strong>Discussion: </strong>Preoperative anemia is a modifiable risk factor for medical and surgical complications within 30 days of TAA. Medical optimization prior to surgical intervention is necessary in patients undergoing TAA.</p><p><strong>Level of evidence: </strong>Level III: Retrospective comparative study.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"133-143"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Foot & ankle specialist","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/19386400221106650","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/6/29 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Although studies have demonstrated the effect of anemia severity on postoperative complications after arthroplasties of the shoulder, hip, and knee, no studies have investigated the effect on total ankle arthroplasty (TAA). The objective was to determine the influence of preoperative anemia severity on complications following TAA.
Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried from 2006 to 2019 for patients undergoing TAA. Utilizing the World Health Organization (WHO) definitions of anemia, patients were stratified into 3 cohorts: nonanemia (hematocrit >36% for women, >39% for men), mild anemia (hematocrit 33%-36% for women, 33%-39% for men), and moderate to severe anemia (hematocrit <33% for both women and men). Demographics, comorbidities, length of stay, and short-term (30-day) postoperative complications were compared between groups. Bivariate analyses, including χ2 and analysis of variance, and multivariable logistical regression were performed.
Results: After exclusion, 1490 patients (1313 nonanemia [88.1%], 154 mild anemia [10.3%], and 23 moderate/severe anemia [1.6%]) were included. Increasing severity of anemia was associated with an increased average hospital length of stay (1.84 vs 2.19 vs 2.78 days, P < .001) and rate of reoperation (0.38% vs 3.90% vs 4.35%, P < .001). There was a statistically significant increase in wound disruptions (0.15% vs 1.95% vs 4.35%, P = .001), minor complications (1.52% vs 4.55% vs 8.70%, P = .008), major complications (1.98% vs 5.84% vs 4.35%, P < .033), and any complications (3.50% vs 10.39% vs 13.04%, P = .001) between groups. Multivariate analysis identified mild and moderate/severe anemia as a predictor of reoperation and extended length of stay (P ≤ .033).
Discussion: Preoperative anemia is a modifiable risk factor for medical and surgical complications within 30 days of TAA. Medical optimization prior to surgical intervention is necessary in patients undergoing TAA.
Level of evidence: Level III: Retrospective comparative study.
背景：虽然已有研究表明贫血严重程度对肩关节、髋关节和膝关节置换术后并发症有影响，但还没有研究调查贫血对全踝关节置换术（TAA）的影响。本研究旨在确定术前贫血严重程度对全踝关节置换术后并发症的影响：方法：查询了美国外科学院国家外科质量改进计划（ACS-NSQIP）2006年至2019年接受TAA手术患者的数据。根据世界卫生组织（WHO）对贫血的定义，将患者分为三组：非贫血（女性血细胞比容>36%，男性血细胞比容>39%）、轻度贫血（女性血细胞比容33%-36%，男性血细胞比容33%-39%）和中重度贫血（血细胞比容2、方差分析和多变量统计回归）：经排除后，共纳入 1490 名患者（1313 名非贫血患者[88.1%]、154 名轻度贫血患者[10.3%]和 23 名中度/重度贫血患者[1.6%]）。贫血严重程度的增加与平均住院时间（1.84 vs 2.19 vs 2.78 天，P < .001）和再次手术率（0.38% vs 3.90% vs 4.35%，P < .001）的增加有关。不同组间的伤口破坏率（0.15% vs 1.95% vs 4.35%，P = .001）、轻微并发症（1.52% vs 4.55% vs 8.70%，P = .008）、主要并发症（1.98% vs 5.84% vs 4.35%，P < .033）和任何并发症（3.50% vs 10.39% vs 13.04%，P = .001）均有统计学意义上的显著增加。多变量分析确定轻度和中度/重度贫血是再次手术和延长住院时间的预测因素（P ≤ .033）：讨论：术前贫血是TAA术后30天内出现内科和外科并发症的一个可改变的危险因素。讨论：术前贫血是导致 TAA 患者在 30 天内出现内科和外科并发症的可调节风险因素：III级：回顾性比较研究。
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