Impact of anemia on incidence of perioperative lower limb deep vein thrombosis in patients undergoing total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIAO Liang ^1,2 , YAO Yao ^1,2 , WU Dengxian ^1,2 , XU Zhihong ^1,2 ,  QIU Junlan ³ ,  JIANG Qing ^1,2

1. Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China;
2. Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing Jiangsu, 210008, P. R. China;
3. Department of Medical Ultrasound, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China;

Corresponding author：

QIU Junlan, Email: weiyumo@163.com; JIANG Qing, Email: qingj@nju.edu.cn

Keywords：

Total hip arthroplasty; perioperative period; anemia; lower limb deep vein thrombosis

DOI：

10.7507/1002-1892.202401083

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the impact of anemia on the incidence of perioperative lower limb deep vein thrombosis (DVT) in patients undergoing total hip arthroplasty (THA). Methods A retrospective analysis was conducted on clinical data of 1 916 non-fracture patients who underwent THA between September 2015 and December 2021, meeting the selection criteria. Among them, there were 811 male and 1 105 female patients, aged between 18 and 94 years with an average of 59.2 years. Among the patients, 213 were diagnosed with anemia, while 1 703 were not. Preoperative DVT was observed in 55 patients, while 1 861 patients did not have DVT preoperatively (of which 75 patients developed new-onset DVT postoperatively). Univariate analysis was performed on variables including age, gender, body mass index (BMI), diabetes, hypertension, history of tumors, history of thrombosis, history of smoking, revision surgery, preoperative D-dimer positivity (≥0.5 mg/L), presence of anemia, operation time, intraoperative blood loss, transfusion requirement, and pre- and post-operative levels of red blood cells, hemoglobin, hematocrit, and platelets. Furthermore, logistic regression was utilized for multivariate analysis to identify risk factors associated with DVT formation. Results Univariate analysis showed that age, gender, hypertension, revision surgery, preoperative levels of red blood cells, preoperative hemoglobin, preoperative D-dimer positivity, and anemia were influencing factors for preoperative DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, preoperative D-dimer positivity, and anemia were risk factors for preoperative DVT (P<0.05). Univariate analysis also revealed that age, female, revision surgery, preoperative D-dimer positivity, anemia, transfusion requirement, postoperative level of red blood cells, and postoperative hemoglobin level were influencing factors for postoperative new-onset DVT (P<0.05). Further logistic regression analysis indicated that age (>60 years old), female, and revision surgery were risk factors for postoperative new-onset DVT (P<0.05). Conclusion The incidence of anemia is higher among patients with preoperative DVT for THA, and anemia is an independent risk factor for preoperative DVT occurrence in THA. While anemia may not be an independent risk factor for THA postoperative new-onset DVT, the incidence of anemia is higher among patients with postoperative new-onset DVT.

Citation： QIAO Liang, YAO Yao, WU Dengxian, XU Zhihong, QIU Junlan, JIANG Qing. Impact of anemia on incidence of perioperative lower limb deep vein thrombosis in patients undergoing total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(5): 570-575. doi: 10.7507/1002-1892.202401083 Copy

1.	Soffin EM, Wainwright TW. Hip and knee arthroplasty. Anesthesiol Clin, 2022, 40(1): 73-90.
2.	Qiao XF, Xue Y, Liu SC, et al. Efficacy of total hip arthroplasty for the treatment of patients with femoral head avascular necrosis: A protocol for systematic review and meta-analysis. Medicine (Baltimore), 2020, 99(20): e20259. doi: 10.1097/MD.0000000000020259.
3.	Mula V, Parikh S, Suresh S, et al. Venous thromboembolism rates after hip and knee arthroplasty and hip fractures. BMC Musculoskelet Disord, 2020, 21(1): 95. doi: 10.1186/s12891-020-3100-4.
4.	Yu X, Wu Y, Ning R. The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care. BMC Musculoskelet Disord, 2021, 22(1): 547. doi: 10.1186/s12891-021-04417-z.
5.	Kaneko T, Nakamura S, Hayakawa K, et al. Preoperative incidence and risk factors of deep vein thrombosis in Japanese patients undergoing total hip arthroplasty. Eur J Orthop Surg Traumatol, 2023, 33(7): 2859-2864.
6.	Xiong X, Li T, Cheng B. Association between glycosylated hemoglobin, diabetes mellitus, and preoperative deep vein thrombosis in patients undergoing total joint arthroplasty: a retrospective study. J Orthop Surg Res, 2022, 17(1): 430. doi: 10.1186/s13018-022-03328-6.
7.	Yao Y, Chai S, Qiao L, et al. An analysis of the prevalence and risk factors of deep vein thrombosis in non-fracture patients awaiting total hip arthroplasty: a retrospective study of 1244 cases. J Orthop Surg Res, 2024, 19(1): 84. doi: 10.1186/s13018-023-04488-9.
8.	Lin J, Wang C, Liu J, et al. Prevalence and intervention of preoperative anemia in Chinese adults: A retrospective cross-sectional study based on national preoperative anemia database. EClinicalMedicine, 2021, 36: 100894. doi: 10.1016/j.eclinm.2021.100894.
9.	Schmidt-Braekling T, Sabri E, Ottawa Arthroplasty Group, et al. Prevalence of anemia and association with outcome in joint arthroplasty—Is there a difference between primary and revision cases? Arch Orthop Trauma Surg, 2024. doi: 10.1007/s00402-024-05247-z.
10.	Xiong X, Xu S, Li T, et al. Correlation of the severity of anemia in patients undergoing total joint arthroplasty with preoperative deep vein thrombosis: a retrospective cohort study. J Orthop Surg Res, 2022, 17(1): 554. doi: 10.1186/s13018-022-03457-y.
11.	葛均波, 徐永健, 王辰, 等. 内科学. 9版. 北京: 人民卫生出版社, 2018: 536.
12.	Wiles P. The surgery of the osteoarthritic hip. Br J Surg, 1958, 45(193): 488-497.
13.	吴东, 刘星宇, 张逸凌, 等. 人工智能辅助全髋关节置换术三维规划系统的研发及临床应用研究. 中国修复重建外科杂志, 2020, 34(9): 1077-1084.
14.	Rubino AS, De Santo LS, Montella AP, et al. Prognostic implication of preoperative anemia in redo cardiac surgery: A single-center propensity-matched analysis. J Cardiovasc Dev Dis, 2023, 10(4): 160. doi: 10.3390/jcdd10040160.
15.	Chardalias L, Papaconstantinou I, Gklavas A, et al. Iron deficiency anemia in colorectal cancer patients: Is preoperative intravenous iron infusion indicated? A narrative review of the literature. Cancer Diagn Progn, 2023, 3(2): 163-168.
16.	Feng S, Greenberg J, Moloo H, et al. Hospital cost associated with anemia in elective colorectal surgery: a historical cohort study. Can J Anaesth, 2019, 66(8): 877-885.
17.	Izuel Rami M, García Erce JA, Gómez-Barrera M, et al. Relationship between allogeneic blood transfusion, iron deficiency and nosocomial infection in patients with hip fracture. Med Clin (Barc), 2008, 131(17): 647-652.
18.	Cochrane NH, Wellman SS, Lachiewicz PF. Early infection after aseptic revision knee arthroplasty: Prevalence and predisposing risk factors. J Arthroplasty, 2022, 37(6S): S281-S285.
19.	Zhang HC, Zhang Y, Dai HB, et al. Preoperative anemia and complications after total joint arthroplasty: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci, 2022, 26(20): 7420-7430.
20.	Viola J, Gomez MM, Restrepo C, et al. Preoperative anemia increases postoperative complications and mortality following total joint arthroplasty. J Arthroplasty, 2015, 30(5): 846-848.
21.	Zhang H, Wu L, Cheng B. Preoperative anemia and deep vein thrombosis in patients with perioperative bone trauma: a cohort study. BMC Musculoskelet Disord, 2022, 23(1): 905. doi: 10.1186/s12891-022-05869-7.
22.	杨天翔, 续量, 张晋宁, 等. 术前贫血对单侧人工全膝关节置换术患者围术期失血量及深静脉血栓的影响. 国际老年医学杂志, 2023, 44(2): 155-158.
23.	Song AB, Kuter DJ, Al-Samkari H. Characterization of the rate, predictors, and thrombotic complications of thrombocytosis in iron deficiency anemia. Am J Hematol, 2020, 95(10): 1180-1186.
24.	龙也, 王通, 刘佳鑫, 等. 重组人促红细胞生成素联合铁剂纠正老年股骨转子间骨折患者围术期贫血的临床研究. 中国修复重建外科杂志, 2019, 33(6): 662-665.
25.	Bailey A, Eisen I, Palmer A, et al. Preoperative anemia in primary arthroplasty patients-prevalence, influence on outcome, and the effect of treatment. J Arthroplasty, 2021, 36(7): 2281-2289.

1. Soffin EM, Wainwright TW. Hip and knee arthroplasty. Anesthesiol Clin, 2022, 40(1): 73-90.
2. Qiao XF, Xue Y, Liu SC, et al. Efficacy of total hip arthroplasty for the treatment of patients with femoral head avascular necrosis: A protocol for systematic review and meta-analysis. Medicine (Baltimore), 2020, 99(20): e20259. doi: 10.1097/MD.0000000000020259.
3. Mula V, Parikh S, Suresh S, et al. Venous thromboembolism rates after hip and knee arthroplasty and hip fractures. BMC Musculoskelet Disord, 2020, 21(1): 95. doi: 10.1186/s12891-020-3100-4.
4. Yu X, Wu Y, Ning R. The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care. BMC Musculoskelet Disord, 2021, 22(1): 547. doi: 10.1186/s12891-021-04417-z.
5. Kaneko T, Nakamura S, Hayakawa K, et al. Preoperative incidence and risk factors of deep vein thrombosis in Japanese patients undergoing total hip arthroplasty. Eur J Orthop Surg Traumatol, 2023, 33(7): 2859-2864.
6. Xiong X, Li T, Cheng B. Association between glycosylated hemoglobin, diabetes mellitus, and preoperative deep vein thrombosis in patients undergoing total joint arthroplasty: a retrospective study. J Orthop Surg Res, 2022, 17(1): 430. doi: 10.1186/s13018-022-03328-6.
7. Yao Y, Chai S, Qiao L, et al. An analysis of the prevalence and risk factors of deep vein thrombosis in non-fracture patients awaiting total hip arthroplasty: a retrospective study of 1244 cases. J Orthop Surg Res, 2024, 19(1): 84. doi: 10.1186/s13018-023-04488-9.
8. Lin J, Wang C, Liu J, et al. Prevalence and intervention of preoperative anemia in Chinese adults: A retrospective cross-sectional study based on national preoperative anemia database. EClinicalMedicine, 2021, 36: 100894. doi: 10.1016/j.eclinm.2021.100894.
9. Schmidt-Braekling T, Sabri E, Ottawa Arthroplasty Group, et al. Prevalence of anemia and association with outcome in joint arthroplasty—Is there a difference between primary and revision cases? Arch Orthop Trauma Surg, 2024. doi: 10.1007/s00402-024-05247-z.
10. Xiong X, Xu S, Li T, et al. Correlation of the severity of anemia in patients undergoing total joint arthroplasty with preoperative deep vein thrombosis: a retrospective cohort study. J Orthop Surg Res, 2022, 17(1): 554. doi: 10.1186/s13018-022-03457-y.
11. 葛均波, 徐永健, 王辰, 等. 内科学. 9版. 北京: 人民卫生出版社, 2018: 536.
12. Wiles P. The surgery of the osteoarthritic hip. Br J Surg, 1958, 45(193): 488-497.
13. 吴东, 刘星宇, 张逸凌, 等. 人工智能辅助全髋关节置换术三维规划系统的研发及临床应用研究. 中国修复重建外科杂志, 2020, 34(9): 1077-1084.
14. Rubino AS, De Santo LS, Montella AP, et al. Prognostic implication of preoperative anemia in redo cardiac surgery: A single-center propensity-matched analysis. J Cardiovasc Dev Dis, 2023, 10(4): 160. doi: 10.3390/jcdd10040160.
15. Chardalias L, Papaconstantinou I, Gklavas A, et al. Iron deficiency anemia in colorectal cancer patients: Is preoperative intravenous iron infusion indicated? A narrative review of the literature. Cancer Diagn Progn, 2023, 3(2): 163-168.
16. Feng S, Greenberg J, Moloo H, et al. Hospital cost associated with anemia in elective colorectal surgery: a historical cohort study. Can J Anaesth, 2019, 66(8): 877-885.
17. Izuel Rami M, García Erce JA, Gómez-Barrera M, et al. Relationship between allogeneic blood transfusion, iron deficiency and nosocomial infection in patients with hip fracture. Med Clin (Barc), 2008, 131(17): 647-652.
18. Cochrane NH, Wellman SS, Lachiewicz PF. Early infection after aseptic revision knee arthroplasty: Prevalence and predisposing risk factors. J Arthroplasty, 2022, 37(6S): S281-S285.
19. Zhang HC, Zhang Y, Dai HB, et al. Preoperative anemia and complications after total joint arthroplasty: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci, 2022, 26(20): 7420-7430.
20. Viola J, Gomez MM, Restrepo C, et al. Preoperative anemia increases postoperative complications and mortality following total joint arthroplasty. J Arthroplasty, 2015, 30(5): 846-848.
21. Zhang H, Wu L, Cheng B. Preoperative anemia and deep vein thrombosis in patients with perioperative bone trauma: a cohort study. BMC Musculoskelet Disord, 2022, 23(1): 905. doi: 10.1186/s12891-022-05869-7.
22. 杨天翔, 续量, 张晋宁, 等. 术前贫血对单侧人工全膝关节置换术患者围术期失血量及深静脉血栓的影响. 国际老年医学杂志, 2023, 44(2): 155-158.
23. Song AB, Kuter DJ, Al-Samkari H. Characterization of the rate, predictors, and thrombotic complications of thrombocytosis in iron deficiency anemia. Am J Hematol, 2020, 95(10): 1180-1186.
24. 龙也, 王通, 刘佳鑫, 等. 重组人促红细胞生成素联合铁剂纠正老年股骨转子间骨折患者围术期贫血的临床研究. 中国修复重建外科杂志, 2019, 33(6): 662-665.
25. Bailey A, Eisen I, Palmer A, et al. Preoperative anemia in primary arthroplasty patients-prevalence, influence on outcome, and the effect of treatment. J Arthroplasty, 2021, 36(7): 2281-2289.

Chinese Journal of Reparative and Reconstructive Surgery

Impact of anemia on incidence of perioperative lower limb deep vein thrombosis in patients undergoing total hip arthroplasty

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content