Mohammed T Al-Nazzawi
NO
Title: Predictors of blood transfusion following total knee replacement at a tertiary care center in Central Saudi Arabia
Biography
Biography: Mohammed T Al-Nazzawi
Abstract
Introduction: Although total knee replacement (TKR) is a common procedure, it may lead to complications such as infections or the need of blood transfusion following the surgery. Previous studies based on data from developed countries found that the incidence rate of blood transfusion following TKR is between 8-18% and identified several risk factors associated with increased risk of blood transfusion. However, data in this area is still limited in Saudi Arabia. Therefore, this study aims to examine the incidence and predictors of blood transfusion following TKR at a large trauma center in Saudi Arabia.
Aim & Objectives: 1. To estimate the incidence rate of blood transfusion following primary TKR at National Guard Hospital in Riyadh, Saudi Arabia. 2. Determine the key predictors of blood transfusion following TKR.
Methods: A retrospective study on 462 cases of adult patients who underwent primary TKR from 2010-2015 at National Guard Hospital (NGH) in Riyadh, Saudi Arabia. Data pertaining to baseline clinical and demographic characteristics, co-morbidities, preoperative hemoglobin (Hb) level, American Society of Anesthesiologist (ASA) score, blood loss and surgery related data, and whether the subject has received blood transfusion were extracted from medical charts. Descriptive statistics were compared by blood transfusion status. To determine the predictors of blood transfusion, all statistical tests were declared significant at a level of 0.05 or less. Significant variables were further included in the logistic regression model.
Results: The overall incidence rate of blood transfusion following TKR surgery was 35.3%. The incidence rate of blood transfusion following unilateral TKR and bilateral TKR, were 27.72% and 73.68%, respectively. The multivariate regression analysis identified bilateral surgery, low preoperative Hb level, and high amount of blood loss as key predictors of blood transfusion.
Discussion: To our knowledge, this is the first study to estimate the incidence rate of blood transfusion following TKR and its predictors in Saudi Arabia. The main findings in study were as follows: (1) The study suggests that the incidence rate of blood transfusion is high. This is particularly true when compared to published literatures where the rates are at least 50% less than our estimate. One important factor leading to such high incidence is the inclusion of subjects with bilateral TKR. (2) However, looking at the rates of unilateral TKR in our study, it suggests that we are 1.5 times higher than the other studies. (3) Our findings suggest that bilateral surgery is associated with a high incidence rate of blood transfusion. It is difficult to judge the magnitude of our findings in the light of lack of similar studies. (4) The predictors of blood transfusion following TKR were low preoperative Hb level, high amount of blood loss, and bilateral TKR.
Conclusion: The estimated rates for blood transfusion presented in this study are much higher than any previously published study. Bilateral surgery, low preoperative Hb level, and high amount of blood loss found to be key predictors of blood transfusion. Quality improvement programs may use these findings to guide initiatives aimed to improve surgery outcomes and reduce patients’ complications.