Risk for perioperative myocardial infarction and mortality in patients undergoing hip or knee arthroplasty: The role of anemia

Carlos Bernardo Mantilla, C. Thomas Wass, Karissa A. Goodrich, Cassie J. Johanns, Michelle L. Kool, Xun Zhu, Jose A. Corredor, David Oman Warner, Michael Joseph Joyner, Daniel J. Berry, Darrell R. Schroeder, Juraj Sprung

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Anemia is common in patients undergoing surgery. This study was designed to determine whether preoperative anemia represents an independent risk factor for 30-day mortality and nonfatal myocardial infarction (death/MI) in patients undergoing major orthopedic arthroplasty surgery. Study design and methods Between January 1987 and December 2006 at the Mayo Clinic, 391 orthopedic patients experienced death/MI within 30 days of the index surgery. For each patient included in the event cohort (case), one control patient (1:1 ratio) was identified matched according to sex, age, type of joint operation (hip vs. knee vs. bilateral knee), primary operation versus revision, emergent versus elective, and date of surgery. Association of preoperative hemoglobin (Hb) with death/MI was assessed by multiple linear regression including preoperative Hb and all other characteristics and comorbid conditions found to have some evidence (p < 0.10) of univariate association with death/MI. Results: After adjusting for other perioperative risk factors, anemia (Hb < 12.0 g/dL for females and <13.0 g/dL for males) was not a significant independent risk factor for death/MI (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.54-1.20; p = 0.286), nor was Hb when treated as a continuous variable (OR, 0.98; 95% CI, 0.81-1.19 per 1.0 g/dL decrease below 13.0 g/dL; p = 0.868). Cardiovascular, cerebrovascular, or pulmonary disease and history of recent malignancy were found to be the most important risk factors for death/MI. Cconclusions: Existing comorbidities, rather than preoperative anemia, were independently associated with major morbidity and mortality in patients undergoing major orthopedic arthroplasty.

Original languageEnglish (US)
Pages (from-to)82-91
Number of pages10
JournalTransfusion
Volume51
Issue number1
DOIs
StatePublished - Jan 2011

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Knee Replacement Arthroplasties
Hip
Anemia
Myocardial Infarction
Mortality
Hemoglobins
Orthopedics
Arthroplasty
Knee
Odds Ratio
Confidence Intervals
Cerebrovascular Disorders
Hip Joint
Ambulatory Surgical Procedures
Lung Diseases
Comorbidity
Linear Models
Cardiovascular Diseases
Morbidity
Neoplasms

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

Risk for perioperative myocardial infarction and mortality in patients undergoing hip or knee arthroplasty : The role of anemia. / Mantilla, Carlos Bernardo; Wass, C. Thomas; Goodrich, Karissa A.; Johanns, Cassie J.; Kool, Michelle L.; Zhu, Xun; Corredor, Jose A.; Warner, David Oman; Joyner, Michael Joseph; Berry, Daniel J.; Schroeder, Darrell R.; Sprung, Juraj.

In: Transfusion, Vol. 51, No. 1, 01.2011, p. 82-91.

Research output: Contribution to journalArticle

Mantilla, Carlos Bernardo ; Wass, C. Thomas ; Goodrich, Karissa A. ; Johanns, Cassie J. ; Kool, Michelle L. ; Zhu, Xun ; Corredor, Jose A. ; Warner, David Oman ; Joyner, Michael Joseph ; Berry, Daniel J. ; Schroeder, Darrell R. ; Sprung, Juraj. / Risk for perioperative myocardial infarction and mortality in patients undergoing hip or knee arthroplasty : The role of anemia. In: Transfusion. 2011 ; Vol. 51, No. 1. pp. 82-91.
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AU - Mantilla, Carlos Bernardo

AU - Wass, C. Thomas

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AU - Johanns, Cassie J.

AU - Kool, Michelle L.

AU - Zhu, Xun

AU - Corredor, Jose A.

AU - Warner, David Oman

AU - Joyner, Michael Joseph

AU - Berry, Daniel J.

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AU - Sprung, Juraj

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AB - Background: Anemia is common in patients undergoing surgery. This study was designed to determine whether preoperative anemia represents an independent risk factor for 30-day mortality and nonfatal myocardial infarction (death/MI) in patients undergoing major orthopedic arthroplasty surgery. Study design and methods Between January 1987 and December 2006 at the Mayo Clinic, 391 orthopedic patients experienced death/MI within 30 days of the index surgery. For each patient included in the event cohort (case), one control patient (1:1 ratio) was identified matched according to sex, age, type of joint operation (hip vs. knee vs. bilateral knee), primary operation versus revision, emergent versus elective, and date of surgery. Association of preoperative hemoglobin (Hb) with death/MI was assessed by multiple linear regression including preoperative Hb and all other characteristics and comorbid conditions found to have some evidence (p < 0.10) of univariate association with death/MI. Results: After adjusting for other perioperative risk factors, anemia (Hb < 12.0 g/dL for females and <13.0 g/dL for males) was not a significant independent risk factor for death/MI (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.54-1.20; p = 0.286), nor was Hb when treated as a continuous variable (OR, 0.98; 95% CI, 0.81-1.19 per 1.0 g/dL decrease below 13.0 g/dL; p = 0.868). Cardiovascular, cerebrovascular, or pulmonary disease and history of recent malignancy were found to be the most important risk factors for death/MI. Cconclusions: Existing comorbidities, rather than preoperative anemia, were independently associated with major morbidity and mortality in patients undergoing major orthopedic arthroplasty.

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