Severe and morbid obesity and transfusional risk in total knee arthroplasty: An observational study.
Knee
; 25(5): 923-931, 2018 Oct.
Article
in En
| MEDLINE
| ID: mdl-30029995
ABSTRACT
BACKGROUND:
Severe and morbid obesity (Class II -III) represents a challenge for successful knee surgery. There isn't consensus on what influence body mass index has on blood loss and on red blood cell (RBC) transfusion during total knee arthroplasty (TKA). The objective was to determine blood loss and transfusion needs in severe and morbid obese patients undertaking TKA.METHODS:
We recorded retrospectively all patients undergoing TKA. Obesity was assessed according to WHO guidelines. Perioperative haemoglobin and treatments for its optimisation were recorded. Blood losses were estimated from specific formulae for lost red-cell mass and percentage of lost blood volume.RESULTS:
922 patients were included 35.90% were obese Class I and 18.76% obese Class II - III. Estimated blood volume was 4390â¯â¯±â¯â¯470â¯ml, 4736â¯â¯±â¯â¯423â¯ml and 5030⯱â¯464â¯ml among non-obese, obese Class I and obese Class II-III, respectively (Pâ¯<â¯0.001). The global estimated blood volume (EBV) lost was 1502â¯â¯±â¯â¯680â¯ml without differences between the three groups. However, the percentage of lost blood volume was lower in obese Class II -III (29.65%) than in non-obese (33.55%) and obese Class I (30.97%) (Pâ¯<â¯0.005). Transfusion rates were 12.7%, 12.1% and 6.4% for non-obese, obese Class I and Class II -III, respectively (Pâ¯=â¯0.062). A negative transfusion risk was predicted for Class II -III patients.CONCLUSIONS:
Severely and morbidly obese patients did not show greater blood loss nor higher RBC transfusion needs after primary TKA than non-obese and obese Class I patients. This could be because obese Class II -III patients had higher EBV but similar RBC losses.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Blood Transfusion
/
Obesity, Morbid
/
Body Mass Index
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Blood Loss, Surgical
/
Perioperative Care
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Arthroplasty, Replacement, Knee
/
Osteoarthritis, Knee
Type of study:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
Language:
En
Journal:
Knee
Journal subject:
ORTOPEDIA
Year:
2018
Document type:
Article