Correlation of body mass index and serum lipid levels in blood management of arthroplasty in elderly patients / 中国组织工程研究

ABSTRACT

BACKGROUND: At present, the number of patients with arthroplasty is increasing year by year. The perioperative hemorrhage is the short-term complication, which severely affects the patient's prognosis and increasing the risk for other complications. More blood transfusions or hemostasis measures are included in the perioperative blood management programs, but with different effects and adverse reactions. OBJECTIVE: To analyze the relationship of body mass index (BMI) and blood lipid level with blood transfusion rate in the perioperative period of arthroplasty and provide evidence for perioperative blood transfusion management of total knee arthroplasty. METHODS: The patients undergoing total hip arthroplasty or total knee arthroplasty at the Changshu No. 2 People's Hospital from 2011 to 2015 were recruited in accordance with the exclusion and inclusion criteria. The basic data of the participants were collected, and all patients accepted arthroplaties. The blood transfusion rate, pre-estimated blood loss, and percentage of blood loss and postoperative complications were recorded and analyzed; the BMI and blood lipid levels were recorded. Correlation analysis and regression analysis were conducted by the statistical software. RESULTS AND CONCLUSION: (1) Totally 513 patients were included in the study, with the mean age of (76.1±9.2) years old, 124 cases in normal BMI group, 229 cases in overweight group, and 160 cases in obesity group. (2) The blood transfusion rate showed significant difference among groups (P=0.002, P=0.002). There were significant differences in the blood loss and percentage of blood loss among groups (All P=0.001), suggesting that with BMI increasing, there was a decrease in blood transfusion rate and percentage of blood loss, and a increase in total blood loss. (3) The incidence of deep infection of the incision was correlated with BMI (P=0.043), and the incidence of other complications was not related to BMI. (4) In the total hip arthropalsty, the total cholesterol level was negatively related to the blood transfusion rate and percentage of blood loss (r=-0.278, P=0.021; r=-0.329, P=0.034), and the triglyceride level was negatively related to the blood transfusion rate (r=-0.449, P=0.014). In the total knee arthroplasty, the total cholesterol level was negatively related to the blood transfusion rate and percentage of blood loss (r=-0.341, P=0.006; r=-0.489, P=0.017). (5) For the blood transfusion rate in the total hip arthroplasty, BMI, total cholesterol and triglyceride levels were the protective factors, and in the total knee arthroplasty, the protective factors were BMI and total cholesterol level. (6) In summary, the blood transfusion rate is negatively related to the BMI, total cholesterol and triglyceride levels in patients undergoing total hip or knee arthroplasty. Patients with higher BMI have a higher total blood loss, lower percentage of blood loss and higher incidence of postoperative deep infection. The above indexes can be used as predictive indexes for the perioperative blood management in joint arthroplasty.