■本研究旨在根据手术类型评估全膝关节置换术(TKA)的输血率和血液管理药物使用率的年度趋势,并分析TKA术后输血的危险因素。
■使用2008年1月至2019年10月之间的797,106个主要和修订TKA的韩国国民保险索赔数据库,有关患者特征的数据,合并症,利用输血,并收集血液管理药物。根据手术类型将患者分为三组:原发性,修订版,同时双侧TKA。比较输血率和血液管理药物(术中氨甲环酸[TXA]和术前补铁)的利用率,并评估输血的危险因素。
■排除不准确的数据后,730,554关节成形术(636,292主要,10,540修订版,并同时确定了41,861个双边TKA)。原发性输血率,修订版,2019年同期双边TKA为64.0%,67.7%,和68.9%,分别,与83.2%相比显著下降,88.0%,2008年分别为92.5%(p<0.001)。相反,术中TXA和术前补铁的利用率从4.6%和13.8%显著提高,分别,2008年分别为52.4%和27.0%,分别,2019年(p<0.001)。术中TXA和术前补铁的使用显着降低了TKA后输血的风险(比值比[OR],0.20;p<0.001和OR,0.71;p<0.001)。
■在2008年至2019年期间,韩国TKA后的输血率从83.5%逐渐下降至64.5%,这与血液管理药物的使用增加相对应。因此,应始终重视患者的血液管理,以降低TKA术后输血率.
UNASSIGNED: This study aimed to evaluate the annual trends of transfusion rates and utilization of blood management agents in total knee arthroplasty (TKA) based on the operation type and to analyze the risk factors of transfusion after TKA.
UNASSIGNED: Using the Korean National Insurance claims database of 797,106 primary and revision TKAs between January 2008 and October 2019, data on the patients\' characteristics, comorbidities, utilization of transfusion, and blood management agents were collected. The patients were categorized into three groups based on the operation type: primary, revision, and simultaneous bilateral TKA. The transfusion rate and utilization of blood management agents (intraoperative tranexamic acid [TXA] and preoperative iron supplements) were compared, and the risk factors for transfusion were evaluated.
UNASSIGNED: After excluding the inaccurate data, 730,554 arthroplasties (636,292 primary, 10,540 revision, and 41,861 simultaneous bilateral TKAs) were identified. The transfusion rates of primary, revision, and simultaneous bilateral TKAs in 2019 were 64.0%, 67.7%, and 68.9%, respectively, which were significantly decreased compared with 83.2%, 88.0%, and 92.5% in 2008, respectively (p < 0.001). Conversely, the utilization of intraoperative TXA and preoperative iron supplements was significantly increased from 4.6% and 13.8%, respectively, in 2008 to 52.4% and 27.0%, respectively, in 2019 (p < 0.001). The utilization of intraoperative TXA and preoperative iron supplements significantly lowered the risk of transfusion after TKA (odds ratio [OR], 0.20; p < 0.001 and OR, 0.71; p < 0.001).
UNASSIGNED: The transfusion rate after TKA decreased gradually from 83.5% to 64.5% between 2008 and 2019 in South Korea corresponding with the increased utilization of blood management agents. Therefore, consistent attention to patient blood management should be emphasized to reduce the transfusion rate after TKA.