Abstract
Background: Postoperative anemia is frequent in patients undergoing hip and knee arthroplasty. While it is legitimate to think that anemia could decrease postoperative vigor and, consequently, limit the patient’s rehabilitation, our previous study showed that anemia does not impair functional recovery in patients during the immediate postoperative period (10 days). Here we investigate the possible relationship between the postoperative hemoglobin (Hb) concentration and long-term (6 months or more) functional recovery and quality of life (QoL) in patients. Study design and methods: A follow-up, observational study was conducted in the 305 patients 60 years and older who underwent major hip or knee arthroplasty and participated in the Transfusion Requirements in Orthopedic Surgery (TRIOS) study (phase 2). The relationship between postoperative Hb concentration (or variation thereof) and primary outcomes (Functional Status Index (FSI) score, scores in the two categories of the Short Form 36 (SF-36) test and adverse events) was established by linear regression. Results: 160 patients responded to long-term follow-up. There were no significant correlations between the postoperative Hb concentration (or the variation in perioperative Hb) and either the FSI or SF-36 scores or adverse events. Consequently, moderate postoperative anemia does not appear to affect long-term (6 months or more after surgery) functional recovery or QoL in patients undergoing a major arthroplasty. Conclusion: Our results confirm the lack of longer-term effects of anemia on functional recovery observed in the immediate postoperative period in the TRIOS phase 2 study.
Highlights
Immediate postoperative anemia is common in patients who undergo a major hip or knee arthroplasty[1]
Contrary to our preliminary hypothesis, we were unable to find a relationship between the immediate postoperative Hb concentration and functional recovery or quality of life (QoL) in patients in the long-term period after a major arthroplasty
There were no significant correlations between postoperative Hb levels and adverse events or morbidities thought to be associated with postoperative anemia
Summary
Immediate postoperative anemia is common in patients who undergo a major hip or knee arthroplasty[1]. The 30 day postoperative death rate and the rates of cardiovascular complications and organ dysfunction were not significantly different with a restrictive strategy (and were even significantly lower in some subgroups), suggesting that patients who undergo surgery are able to tolerate Hb levels much lower than those previously admitted According to these results, it seems that the use of a restrictive transfusion strategy does not affect mortality or morbidity in the immediate postoperative period (30 days after surgery). As described in the meta-analysis by Alvarez et al 2001, many studies have shown that the human body can adapt to lower [Hb] by increasing cardiac output and oxygen extraction along with a decrease in blood viscosity[6] These adaptive changes could explain the similar results observed when using restrictive and liberal transfusion strategies. Conclusion: Our results confirm the lack of longer-term effects of anemia on functional recovery observed in the immediate postoperative period in the TRIOS phase 2 study
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