Abstract
BackgroundEnhanced recovery after surgery (ERAS) program advocates implementation of perioperative goal-directed fluid therapy and reduced application of colloidal fluids. It should be used reasonably selectively in high-risk patients despite the clear efficacy of human albumin (HA). Therefore, it is vital to identify the risk factors for the use of HA. This study aims to determine the incidence and risk factors of HA administration in patients undergoing total hip or knee arthroplasty (THA, TKA).MethodsWe identified patients undergoing THA or TKA in multiple institutions from 2014 to 2016 and collected patient demographics and perioperative variables. The criterion of HA administration was defined as a postoperative albumin level < 32 g/L or 32 to 35 g/L for at-risk patients. We compared 14 variables between patients who received HA administration and those who did not after stratification by the preoperative albumin (pre-ALB) level. Multivariable regressions identified the independent risk factors associated with HA administration.ResultsIn total, 958 (20.3%) of 4713 patients undergoing THA and 410 (9.7%) of 4248 patients undergoing TKA received HA administration. In addition to pre-ALB < 35 g/L, preoperative anemia (odds ratio [OR] 2.12, P = 0.001; OR 1.39, P < 0.001) and drain use (OR 3.33, P = 0.001; OR 4.25, P < 0.001) were also independent risk factors for HA administration after THA regardless pre-ALB < 35 g/L or not, and patients undergoing TKA diagnosed of rheumatoid arthritis or ankylosing spondylitis tended to receive HA administration regardless pre-ALB < 35 g/L or not (OR 3.67, P = 0.002; OR 2.06, P < 0.001).ConclusionsThe incidence of HA administration was high in patients undergoing THA or TKA, and several variables were risk factors for HA administration. This finding may aid surgeons in preoperatively identifying patients requiring HA administration and optimizing perioperative managements.
Highlights
Total joint arthroplasty (TJA) is a successful orthopedic procedure and the full numbers increase year by year [1]
The results of the comparison of demographic characteristics and perioperative factors between human albumin (HA) and nonHA groups in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) are shown in Supplemental Tables 1 and 2, which were greatly influenced by differences in preoperative albumin (pre-ALB) levels
For patients undergoing THA, HA administration was associated with diagnosis, preoperative anemia, anesthesia, anticoagulant use, and drain use in those with pre-ALB < 35 g/L (P < 0.05), which was associated with age, sex, diagnosis, American Society of Anesthesiologists (ASA) class, preoperative anemia, surgical type, anesthesia, anticoagulant use, colloid solution use, and drain use in those with pre-ALB ≥ 35 g/L (P < 0.05) (Table 1)
Summary
Total joint arthroplasty (TJA) is a successful orthopedic procedure and the full numbers increase year by year [1]. Human albumin (HA) is a colloid that can be used to treat hypoalbuminemia (< 35 g/L) and has been shown to increase postoperative albumin levels and reduce postoperative complications [6, 7] It should be used reasonably selectively in those highrisk patients rather than unrestrained, because of its high cost and possible risk of anaphylaxis, renal insufficiency, and cardiac complications, especially for elderly patients undergoing TJA [8,9,10]. Enhanced recovery after surgery (ERAS) program advocates implementation of perioperative goaldirected fluid therapy and reduced application of colloidal fluids It should be used reasonably selectively in highrisk patients despite the clear efficacy of human albumin (HA). This study aims to determine the incidence and risk factors of HA administration in patients undergoing total hip or knee arthroplasty (THA, TKA)
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