Hidden blood loss and its influential factors after total hip arthroplasty

Kaisong Miao, Su Ni, Xianju Zhou, Nanwei Xu, Rongbin Sun, Chao Zhuang, Yuji Wang, Kaisong Miao, Su Ni, Xianju Zhou, Nanwei Xu, Rongbin Sun, Chao Zhuang, Yuji Wang

Abstract

Background: Total hip arthroplasty (THA) is a vital therapy for various hip joint diseases. However, patients have lower hemoglobin level post-operatively, remarkably inconsistent with the measured blood loss. The inconsistence is majorly attributed to hidden blood loss (HBL). In this study, we investigated the HBL and its influential factors among patients after THA.

Methods: From January 2008 to June 2014, 322 patients (99 males and 223 females) undergoing THA were enrolled in this study. All patients were assessed comprehensively before the operation. The demographic information of the patients was collected. Intra-operative and post-operative blood loss was recorded, and then, the total perioperative blood loss and the HBL were calculated. Influential factors were further analyzed by multiple and stepwise regression.

Results: The HBL was 429 ± 223 mL, with a percentage of 35.4% ± 11.0% in the total perioperative blood loss (1,155 ± 377 mL). Multiple and stepwise regression analysis revealed that HBL was positively associated with body mass index (BMI), blood transfusion volume, length of incision, change of hematocrit (HCT) between pre-operation and post-operation but negatively associated with age. As compared to male patients, female patients had a risk of increased HBL. Development displasia hip (DDH) patients had a less risk of HBL in all patients.

Conclusion: HBL is a significant portion of total blood loss in the patients after THA. Gender, age, BMI, blood transfusion, length of incision, change of HCT, and diagnosis are influential factors of HBL.

References

    1. Eriksson BI, Dahl OE, Buller HR, Hettiarachchi R, Rosencher N, Bravo ML, et al. A new oral direct thrombin inhibitor, dabigatran etexilate, compared with enoxaparin for prevention of thromboembolic events following total hip or knee replacement: the BISTRO II randomized trial. J Thromb Haemost. 2005;3:103–11. doi: 10.1111/j.1538-7836.2004.01100.x.
    1. Borgen PO, Dahl OE, Reikeras O. Blood loss in cemented THA is not reduced with postoperative versus preoperative start of thromboprophylaxis. Clin Orthop Relat Res. 2012;470:2591–8. doi: 10.1007/s11999-012-2320-9.
    1. Li J, Zhou Y, Jing J, Zhan J. [Comparison of effects of two anticoagulants on hidden blood loss after total hip arthroplasty] Chin J Reparative Reconstr Surg. 2013;27:432–5.
    1. Liu X, Zhang X, Chen Y, Wang Q, Jiang Y, Zeng B. Hidden blood loss after total hip arthroplasty. J Arthroplasty. 2011;26:1100–5. doi: 10.1016/j.arth.2010.11.013.
    1. Lostak J, Galo J, Mlcuchova D. [Multivariate analysis of blood loss during primary total hip or knee arthroplasty] Acta Chir Orthop Traumatol Cech. 2013;80:219–25.
    1. Alshryda S, Mason J, Sarda P, Nargol A, Cooke N, Ahmad H, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: a randomized controlled trial (TRANX-H) J Bone Joint Surg Am. 2013;95:1969–74. doi: 10.2106/JBJS.L.00908.
    1. Rosencher N, Kerkkamp HE, Macheras G, Munuera LM, Menichella G, Barton DM, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003;43:459–69. doi: 10.1046/j.1537-2995.2003.00348.x.
    1. Keating EM, Meding JB. Perioperative blood management practices in elective orthopaedic surgery. J Am Acad Orthop Surg. 2002;10:393–400.
    1. Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee. 2000;7:151–5. doi: 10.1016/S0968-0160(00)00047-8.
    1. Pattison E, Protheroe K, Pringle RM, Kennedy AC, Dick WC. Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis. 1973;32:582–4. doi: 10.1136/ard.32.6.582.
    1. Faris PM, Ritter MA, Keating EM, Valeri CR. Unwashed filtered shed blood collected after knee and hip arthroplasties. A source of autologous red blood cells. J Bone Joint Surg Am. 1991;73:1169–78.
    1. Erskine JG, Fraser C, Simpson R, Protheroe K, Walker ID. Blood loss with knee joint replacement. J R Coll Surg Edinb. 1981;26:295–7.
    1. Bao N, Zhou L, Cong Y, Guo T, Fan W, Chang Z, et al. Free fatty acids are responsible for the hidden blood loss in total hip and knee arthroplasty. Med Hypotheses. 2013;81:104–7. doi: 10.1016/j.mehy.2013.03.038.
    1. Cushner FD, Friedman RJ. Blood loss in total knee arthroplasty. Clin Orthop Relat Res. 1991;269:98–101.
    1. Shen HL, Li Z, Feng ML, Cao GL. Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis. Chin Med J (Engl) 2011;124:1653–6.
    1. Zhao J, Li J, Zheng W, Liu D, Sun X, Xu W. Low body mass index and blood loss in primary total hip arthroplasty: results from 236 consecutive ankylosing spondylitis patients. BioMed Res Int. 2014;2014:742393.
    1. Bell TH, Berta D, Ralley F, Macdonald SJ, McCalden RW, Bourne RB, et al. Factors affecting perioperative blood loss and transfusion rates in primary total joint arthroplasty: a prospective analysis of 1642 patients. Can J Surg. 2009;52:295–301.
    1. Good L, Peterson E, Lisander B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90:596–9. doi: 10.1093/bja/aeg111.
    1. Zhou XD, Tao LJ, Li J, Wu LD. Do we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen randomized controlled trials. Arch Orthop Trauma Surg. 2013;133:1017–27. doi: 10.1007/s00402-013-1761-2.
    1. Zhou XD, Li J, Xiong Y, Jiang LF, Li WJ, Wu LD. Do we really need closed-suction drainage in total hip arthroplasty? A meta-analysis. Int Orthop. 2013;37:2109–18. doi: 10.1007/s00264-013-2053-8.
    1. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58:277–80. doi: 10.1097/00000542-198303000-00016.
    1. Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg. 2004;86:561–5.
    1. Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop. 2007;31:39–44. doi: 10.1007/s00264-006-0096-9.
    1. Chang CH, Chang Y, Chen DW, Ueng SW, Lee MS. Topical tranexamic acid reduces blood loss and transfusion rates associated with primary total hip arthroplasty. Clin Orthop Relat Res. 2014;472:1552–7. doi: 10.1007/s11999-013-3446-0.
    1. Konig G, Hamlin BR, Waters JH. Topical tranexamic acid reduces blood loss and transfusion rates in total hip and total knee arthroplasty. J Arthroplasty. 2013;28:1473–6. doi: 10.1016/j.arth.2013.06.011.
    1. Yue C, Kang P, Yang P, Xie J, Pei F. Topical application of tranexamic acid in primary total hip arthroplasty: a randomized double-blind controlled trial. J Arthroplasty. 2014;29:2452–6. doi: 10.1016/j.arth.2014.03.032.
    1. Aguilera-Roig X, Jordan-Sales M, Natera-Cisneros L, Monllau-Garcia JC, Martinez-Zapata MJ. [Tranexamic acid in orthopedic surgery] Revista espanola de cirugia ortopedica y traumatologia. 2014;58:52–6. doi: 10.1016/j.recot.2013.08.005.

Source: PubMed

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