RESUMEN
OBJECTIVE: Establish whether the use of starch in hip arthroplasty is a risk factor for excessive surgical bleeding and requirement of red blood cell transfusion. METHOD: Analytical observational retrospective study in 240 patients who underwent primary total hip arthroplasty from January 2015 to January 2016. Two groups were formed: starch (94 patients) and non-starch (146 patients). Age, sex, body mass index, preoperative and postoperative hemoglobin, red cell transfusion and surgical bleeding was analyzed. RESULTS: Starchy group had increased risk of excessive surgical bleeding (OR: 3.58; 95% CI: 2.05- 6.26) and red blood cells transfusion (OR: 3.12; 95% CI: 1.76 -5.5). In the starch group average surgical bleeding was 396 ml (SD: ± 234.94) and a decrease in hemoglobin of 4.6 g/dl (SD± 1.38). The control group had an average bleeding of 271.8 ml (SD: ± 139.22) and decrease in hemoglobin of 3.34 g/dl (SD: ± 1.4). DISCUSSION: The starch group had higher surgical bleeding and required more often red blood cells transfusion than the non-starch group. We suggest to take in account the possible complications related to the use hydroxyethyl starch.
OBJETIVO: Determinar si el uso de almidón en la artroplastia de cadera es un factor de riesgo para el sangrado transquirúrgico excesivo y el uso de concentrados eritrocitarios. MÉTODO: Estudio retrospectivo observacional analítico de 240 pacientes sometidos a artroplastia total de cadera primaria desde enero de 2015 hasta enero de 2016. Se integraron dos grupos: almidón (94 pacientes) y no almidón (146 pacientes). Se analizaron la edad, el sexo, el índice de masa corporal, la hemoglobina prequirúrgica y posquirúrgica, el uso de concentrados eritrocitarios y el sangrado transquirúrgico. RESULTADOS: El grupo con almidón tuvo mayor riesgo de sangrado transquirúrgico excesivo (odds ratio [OR]: 3.58; intervalo de confianza del 95% [IC 95%]: 2.05- 6.26) y de transfusión de concentrados eritrocitarios (OR: 3.12; IC 95%: 1.76-5.5). En el grupo con almidón hubo una media de sangrado transquirúrgico de 396 ml (desviación estándar [DE]: ± 234.94) y una disminución de la hemoglobina de 4.6 g/dl (DE: ± 1.38); en el grupo de no almidón hubo una media de sangrado de 271.8 ml (DE: ± 139.22) y una disminución de la hemoglobina de 3.34 g/dl (DE: ± 1.4). DISCUSIÓN: Los pacientes con almidón presentaron mayor sangrado transquirúrgico y requirieron en más ocasiones la transfusión de hemoderivados que los del grupo control, por lo que sugerimos considerar las posibles complicaciones relacionadas con el uso de hidroxietilalmidón.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Pérdida de Sangre Quirúrgica , Derivados de Hidroxietil Almidón/efectos adversos , Sustitutos del Plasma/efectos adversos , Factores de Edad , Anciano , Índice de Masa Corporal , Estudios de Casos y Controles , Intervalos de Confianza , Transfusión de Eritrocitos , Femenino , Hemoglobina A/análisis , Humanos , Derivados de Hidroxietil Almidón/administración & dosificación , Masculino , Oportunidad Relativa , Sustitutos del Plasma/administración & dosificación , Estudios Retrospectivos , Factores de Riesgo , Factores SexualesRESUMEN
BACKGROUND: During total knee arthroplasty (TKA), total synovectomy (TS) as a part of the surgical technique has been proposed to reduce the inflammatory tissue after the procedure, but there is a controversy about it because of the risk of major postsurgical bleeding. The aim of this study was to compare postoperative bleeding, pain, and health-related quality of life (HRQOL) after a TKA when a TS is performed and when it is not. METHODS: The difference in pre and postoperative hemoglobin was measured, as well as postoperative pain using visual analogue scale (VAS) scores at 24 and 48 h post-surgical, HRQOL was measured prior to surgery and at one year using the SF-12V2 questionnaire. RESULTS: We assessed a total of 148 patients (73 for TS and 75 for limited synovectomy). We have found a difference of 0.9 mg/dl of pre- and postoperative hemoglobin between both groups, with a higher bleeding amount for the TS group (P = 0.0000647); VAS scores were slightly lower for the TS group at 24 and 48 h after surgery, but not relevant. The TS group required transfusion in 13.3% and the limited synovectomy group in 6.8%. No significant differences in HRQOL were found in both groups at 1 year follow-up. CONCLUSIONS: Performing a TS in TKA in patients with osteoarthrosis does not result in a relevant lower postoperative pain, or in an improvement in HRQOL, and it does increase the amount of bleeding after the procedure.