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Avoid Cardiac Complications, Renal complications, and More in TSA: Look Out for Anemia

Elizabeth Hofheinz, M.P.H., M.Ed.

A team of researchers from the Renaissance School of Medicine at Stony Brook University, and the Department of Orthopaedics, Stony Brook University, recently took note that while preoperative anemia has been identified as a predictor for numerous postoperative complications in total shoulder arthroplasty (TSA), the relationship between the severity of the preop anemia and its relationship to postop complications remains unclear.

Their work, “The Impact of Preoperative Anemia on Complications After Total Shoulder Arthroplasty,” was published in the January 2021 edition of JAAOS Global Research & Reviews.

To address the gap in the literature, the researchers set upon analyzing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to determine the relationship between varying levels of preop anemia and postop complications within 30 days of TSA. They looked at all patients who underwent TSA (anatomic and reverse) between 2015 and 2017; patients under 18 were excluded.

Co-author Edward D. Wang, M.D. told OSN: “Anemia is a common condition estimated to affect 11% of the population older than the age of 65 years. Within the context of TSA, preoperative anemia has been identified as a predictor for many postoperative complications including postoperative anemia requiring transfusion, extended length of stay, and pulmonary embolism.”

The authors wrote: “A total of 10,547 patients were included in the study. Of these patients, 1,923 patients were (18.2%) in the mild anemia cohort and 146 (1.4%) were in the severe anemia cohort. Mild anemia was identified as a significant predictor of any complication, stroke/cerebrovascular accident, postoperative anemia requiring transfusion, nonhome discharge, readmission, and return to the surgical room. Severe anemia was identified as a significant predictor of any complication, renal complication, postoperative anemia requiring transfusion, and nonhome discharge.”

Dr. Wang: “Our study identified a notably increased complication rate (11.0%) among anemic patients versus normal hematocrit patients (3.1%) and a notable association between an increasing rate of complications and increasing severity of preoperative anemia.”

“We identified anemia as a risk factor for cardiac complications, renal complications, stroke/CVA, sepsis, UTI, postoperative anemia requiring transfusion, non-home discharge, hospital readmission, and return to the surgical room within 30 days of TSA.”

“Many patients undergoing TSA are anemic. This study identified a notable association between complication rates and increasing severity of preoperative anemia. Identification of anemia as a risk factor may assist orthopedic surgeons in risk stratification and preoperative patient counseling.”

Asked how he might go about studying this topic further, Dr. Wang told OSN: “The present study did not evaluate the impact of correcting patients’ hematocrit preoperatively on postoperative complications after TSA. Further research investigating the impact of optimizing patients’ preoperative hematocrit levels on reducing complication rates after TSA is needed to further understand this relationship.”

Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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