Abstract：
Primary unilateral total joint arthroplasty (TJA) is associated with acute postoperative anemia that may require blood transfusion. Clinicians may worry about discharging patients after surgery who experience substantial decreases in hemoglobin (Hgb), even if their Hgb is above restrictive transfusion thresholds. The purpose of this study was to determine whether differences between preoperative and postoperative Hgb values (Delta) correlate with 90-day readmission in patients who did not receive perioperative transfusions.
A retrospective review of patients undergoing primary unilateral TJA between 2015 and 2020 was performed. The primary outcome was whether a specific cutoff delta Hgb was predictive of readmission within 90 days due to anemia-related causes. Secondary outcomes included the presence of acute postoperative anemia and transfusion during readmission.
Six thousand seven hundred and ninety one patients had a median delta Hgb of 2.80. In total, 268 patients (3.95%) were readmitted within 90 days postoperatively, with two patients requiring transfusion during readmission. A significantly higher rate of readmission was found in patients with cardiovascular disease (5.16% versus 3.68%; P = .020). When constructing receiver operating characteristic curves, a cutoff value of 3.20 resulted in an area under curve of 0.595 (0.486-0.704). In patients with cardiovascular disease, a cutoff value of 3.10 resulted in an area under curve of 0.626 (0.466-0.787).
The magnitude of Hgb change was not predictive of anemia-related readmission within 90 days in patients who did not receive a perioperative transfusion. Patients experiencing higher delta Hgb values but remaining above the transfusion threshold may have a greater physiologic reserve.
A retrospective review of patients undergoing primary unilateral TJA between 2015 and 2020 was performed. The primary outcome was whether a specific cutoff delta Hgb was predictive of readmission within 90 days due to anemia-related causes. Secondary outcomes included the presence of acute postoperative anemia and transfusion during readmission.
Six thousand seven hundred and ninety one patients had a median delta Hgb of 2.80. In total, 268 patients (3.95%) were readmitted within 90 days postoperatively, with two patients requiring transfusion during readmission. A significantly higher rate of readmission was found in patients with cardiovascular disease (5.16% versus 3.68%; P = .020). When constructing receiver operating characteristic curves, a cutoff value of 3.20 resulted in an area under curve of 0.595 (0.486-0.704). In patients with cardiovascular disease, a cutoff value of 3.10 resulted in an area under curve of 0.626 (0.466-0.787).
The magnitude of Hgb change was not predictive of anemia-related readmission within 90 days in patients who did not receive a perioperative transfusion. Patients experiencing higher delta Hgb values but remaining above the transfusion threshold may have a greater physiologic reserve.
摘要：
原发性单侧全关节置换术（TJA）与可能需要输血的急性术后贫血有关。临床医生可能会担心手术后血红蛋白（Hgb）大幅下降的患者出院，即使他们的Hgb高于限制性输血阈值。这项研究的目的是确定术前和术后Hgb值（Delta）之间的差异是否与未接受围手术期输血的患者的90天再入院相关。
对2015年至2020年接受原发性单侧TJA的患者进行了回顾性回顾。主要结果是特定的截断值δHgb是否可以预测90天内由于贫血相关原因而再次入院。次要结果包括急性术后贫血和再入院期间输血。
六千七百九十一名患者的中位Hgb为2.80。总的来说,268例患者（3.95%）在术后90天内再次入院，两名患者在再次入院期间需要输血。心血管疾病患者的再入院率明显较高（5.16%vs3.68%；P=0.020）。当构建接收器工作特性曲线时，截止值3.20导致曲线下面积为0.595(0.486-0.704).在心血管疾病患者中，截止值3.10导致曲线下面积为0.626(0.466-0.787).
在未接受围手术期输血的患者中，Hgb变化的幅度不能预测90天内贫血相关的再入院。经历较高的δHgb值但仍高于输血阈值的患者可能具有更大的生理储备。
对2015年至2020年接受原发性单侧TJA的患者进行了回顾性回顾。主要结果是特定的截断值δHgb是否可以预测90天内由于贫血相关原因而再次入院。次要结果包括急性术后贫血和再入院期间输血。
六千七百九十一名患者的中位Hgb为2.80。总的来说,268例患者（3.95%）在术后90天内再次入院，两名患者在再次入院期间需要输血。心血管疾病患者的再入院率明显较高（5.16%vs3.68%；P=0.020）。当构建接收器工作特性曲线时，截止值3.20导致曲线下面积为0.595(0.486-0.704).在心血管疾病患者中，截止值3.10导致曲线下面积为0.626(0.466-0.787).
在未接受围手术期输血的患者中，Hgb变化的幅度不能预测90天内贫血相关的再入院。经历较高的δHgb值但仍高于输血阈值的患者可能具有更大的生理储备。
