常规术后全血细胞计数评估在选择性髋关节和膝关节置换术中是不必要的：一项前瞻性队列研究

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-06-14 DOI:10.1016/j.jcot.2025.103099

David Moore , Henry Turner , Jess Rotaru , Ciara Doran , James Cashman

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引用次数: 0

摘要

髋关节和膝关节置换术是世界范围内最常见的骨科手术之一，可能与大量失血有关。常规血红蛋白取样增加了输血率，但总体上没有降低发病率和死亡率，然而提供者通常采用绝对数值作为术后输血的保证。我们的目的是确定需要输血的血红蛋白显著减少的患者比例，从而评估在接受全关节置换术的住院和门诊患者队列中常规术后血红蛋白评估的必要性。方法：我们对2018年至2023年在城市三级转诊中心由一名外科医生进行的所有初级选择性髋关节和膝关节置换术病例的机构数据库中前瞻性收集的数据进行了回顾。我们评估了患者的术前和术后变量，以确定手术后输血的预测因素。所有统计数据均使用Stata release 17进行。结果：在6年内，490例患者接受了选择性髋关节或膝关节置换术，术后血红蛋白平均下降2.1 g/dL （SD 1.0，范围- 5.6至+1）。4例（0.8%）患者血红蛋白低于8 g/dL， 19例（3.9%）患者血红蛋白低于9 g/dL，但只有4例（0.8%）患者需要输血。106例患者（21.9%）接受了一日关节置换术，手术90天内无再次入院或并发症。结论选择性TJA术后常规监测血红蛋白成本高且不必要，且不能提供可操作的信息。我们建议术前血红蛋白水平大于11g /dL的患者可能不需要术后常规全血细胞计数，因为血红蛋白平均下降低于3g /dL是可以预期的。我们继续主张，根据麻醉预评估时的ASA等级，在适当选择的患者中进行一日关节置换术是安全的。证据水平：II级——前瞻性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Routine post-operative full blood count assessment is not necessary in elective hip and knee arthroplasty: A prospective cohort study

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Routine post-operative full blood count assessment is not necessary in elective hip and knee arthroplasty: A prospective cohort study

Background

Hip and knee arthroplasty are among the commonest orthopaedic procedures performed worldwide and can be associated with significant blood loss. Routine haemoglobin sampling increases transfusion rates without an overall reduction in morbidity and mortality, yet providers commonly adopt an absolute numerical value as warranting transfusion post-operatively. Our aim was to establish what proportion of patients had a significant reduction in haemoglobin requiring transfusion thus assessing the necessity of routine post-operative haemoglobin assessment in an inpatient and outpatient patient cohort undergoing total joint replacement.

Methods

We performed a review of prospectively collected data in an institutional database of all primary elective hip and knee arthroplasty cases performed by a single surgeon at an urban tertiary referral centre from 2018 to 2023. We assessed pre-operative and post-operative variables amongst patients to identify predictors for transfusion following surgery. All statistics were performed using Stata release 17.

Results

490 elective primary hip or knee arthroplasty procedures were performed within the six year period of which the mean drop in haemoglobin was 2.1 g/dL (SD 1.0, Range −5.6 to +1) post-operatively. Four patients (0.8 %) had a haemoglobin drop below 8 g/dL and 19 (3.9 %) had a level below 9 g/dL, however only 4 patients (0.8 %) required allogenic blood transfusion. One hundred and six patients (21.9 %) underwent day-case arthroplasty of which there was no re-admissions or complications within 90 days of surgery.

Conclusion

The routine monitoring of haemoglobin following elective TJA is costly and unnecessary whilst not contributing to actionable information. We recommend that patients with a pre-operative level greater than 11 g/dL may not require routine post-operative full blood count as mean drop in haemoglobin of less than 3 g/dL can be expected. We continue to advocate that day-case arthroplasty is safe in appropriately selected patients as defined by ASA grade at anaesthetic pre-assessment.

Level of evidence

Level II – Prospective cohort study.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.