Correlation between blood loss during primary total knee arthroplasty and hypoalbuminemia and hypocalcemia after arthroplasty

doi:10.12307/2022.062

Abstract

Abstract: BACKGROUND: Even under the concept of enhanced recovery after surgery, most elderly patients undergoing primary total knee arthroplasty have hypocalcemia and hypoalbuminemia in the short term after surgery. Therefore, it is necessary to explore the causes and early warning factors to implement early intervention, thereby trying to avoid the negative effects caused by the above complications.
OBJECTIVE: To investigate the total blood loss and the incidence of hypoalbuminemia and hypocalcemia after primary total knee arthroplasty, further explore the correlation between the amount of blood loss and the changes of albumin and serum calcium before and after surgery.
METHODS: The medical records of 184 patients who underwent primary unilateral total knee arthroplasty in the Department of Sports Medicine and Joint Surgery, People’s Hospital of Liaoning Province from January 2019 to October 2020 were collected and retrospectively analyzed. Gross formula was used to calculate blood loss. Pearson correlation was used to analyze the correlation between the changes of serum calcium and albumin before and after operation and the age of patients, and the correlation between the amount of blood loss after operation and the length of operation, the changes of albumin, and the changes of serum calcium. The linear regression equation was established with the changes of albumin and serum calcium before and after operation as independent variables and the blood loss as dependent variables. Finally, the optimal linear regression equation model was established by multiple linear regression analysis (stepwise method) with the changes of albumin and serum calcium before and after operation as independent variables and the blood loss as dependent variables.
RESULTS AND CONCLUSION: (1) The incidence of hypoproteinemia after primary total knee arthroplasty was 59.8%, and the incidence of hypocalcemia after arthroplasty was 76.6%. (2) Non-major component blood transfusion had no effect on changes in albumin and serum calcium before and after arthroplasty. (3) There was a significant positive correlation between the changes in serum calcium and albumin before and after arthroplasty and the age of the patient. There was a very significant positive correlation of the amount of blood loss after surgery with the change in albumin after arthroplasty and the change in serum calcium after arthroplasty. (4) Linear regression analysis results showed the correlation between theoretical blood loss and changes in serum calcium: Y=41.294+2 313.383X, R2(after adjustment)=0.459; correlation between theoretical blood loss and changes in blood albumin Y=57.084+59.392X, R2(after adjustment)=0.406. Using blood loss (Y) as the dependent variable and serum calcium change (X1) and albumin change (X2) as independent variables, the optimal linear regression equation was established: Y=-30.91+1 548.931X1+30.029X2, R2 (after adjustment)=0.511. (5) It is indicated that according to the physical condition of the elderly patients who are expected to have a large amount of blood loss, the intervention measures can be implemented to maintain the stability of albumin and calcium ion in the perioperative period. The elderly patients who receive primary total knee arthroplasty whose preoperative albumin test results are lower than 42.44 g/L should strengthen nutrition, formulate the corresponding dietary plan or oral/intravenous albumin supplement. It is necessary to use calcium orally or intravenously in elderly patients who have received primary total knee arthroplasty and preoperative serum calcium test results are lower than 2.398 mmol/L in order to prevent hypocalcemia and hypoalbuminemia.

Key words: primary total knee arthroplasty, blood loss, hypocalcemia, hypoalbuminemia, multiple linear regression

CLC Number:

Qu Pengfei, Wang Huisheng, Li Xi. Correlation between blood loss during primary total knee arthroplasty and hypoalbuminemia and hypocalcemia after arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(3): 376-382.

Figures/Tables 12

References

[1] LI J, ZHU H, LIAO R. Enhanced recovery after surgery (ERAS) pathway for primary hip and knee arthroplasty: study protocol for a randomized controlled trial. Trials. 2019;20:599.
[2] TILLE E, MYSLIWIETZ J, BEYER F, et al.Intraarticular use of tranexamic acid reduces blood loss and transfusion rate after primary total knee arthroplasty. BMC Musculoskelet Disord. 2019;20(1):341.
[3] LI ZJ, ZHAO MW, ZENG L. Additional Dose of Intravenous Tranexamic Acid after Primary Total Knee Arthroplasty Further Reduces Hidden Blood Loss. Chin Med J (Engl). 2018;131(6):638-642.
[4] VORA M, SING DC, YI PH, et al. Hypoalbuminemia is a risk factor for predicting early postoperative complications after proximal humerus fracture fixation. J Orthop. 2019;19:106-110.
[5] BLEVINS K, AALIREZAIE A, SHOHAT N, et al. Malnutrition and the Development of Periprosthetic Joint Infection in Patients Undergoing Primary Elective Total Joint Arthroplasty. J Arthroplasty. 2018;33(9): 2971-2975.
[6] NWACHUKWU BU, DY CJ, BURKET JC, et al. Risk for Complication after Total Joint Arthroplasty at a Center of Excellence: The Impact of Patient Travel Distance. J Arthroplasty. 2015;30:1058-1061.
[7] ROBINSON TN, RAEBURN CD, TRAN ZV, et al. Postoperative Delirium in the Elderly: Risk Factors and Outcomes. Ann Surg. Ann Surg. 2009; 249(1):173-178.
[8] YATES AJ JR; AMERICAN ASSOCIATION OF HIP AND KNEE SURGEONS EVIDENCE-BASED MEDICINE COMMITTEE. Postoperative prophylactic antibiotics in total joint arthroplasty. Arthroplast Today. 2018;4(1): 130-131.
[9] SCHIAVON CA, BERSCH-FERREIRA AC, SANTUCCI EV, et al. Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension). Circulation. 2018;137(11):1132-1142.
[10] YU Q, LIU K, MA D, et al. Do Symptoms and Serum Calcium Levels Affect the Results of Surgical Treatment of Primary Hyperparathyroidism? Biomed Res Int. 2019;2019:2150159.
[11] GAI P, SUN H, SUI L, et al. Hypocalcaemia After Total Knee Arthroplasty and its Clinical Significance. Anticancer Res. 2016;36(3):1309-1311.
[12] 刘子桃, 黄永明. 膝关节置换患者围手术期钠、钾、钙离子水平的变化及临床意义[J]. 当代医学,2012,18(23):22-24.
[13] MATTSSON JP, VÄÄNÄNEN K, WALLMARK B, et al. Omeprazole and bafilomycin, two proton pump inhibitors: Differentiation of their effects on gastric, kidney and bone H+-translocating ATPases. Biochim Biophys Acta. 1991;1065(2):261-268.
[14] BAHTIRI E, ISLAMI H, HOXHA R, et al. Proton pump inhibitor use for 12 months is not associated with changes in serum magnesium levels: a prospective open label comparative study. Turk J Gastroenterol. 2017;28(2):104-109.
[15] LEE L, RAMOS-ALVAREZ I, ITO T, et al. Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome. Int J Mol Sci. 2019;20(20):5128.
[16] BIHORAC A, ROSS EA. Continuous Venovenous Hemofiltration With Citrate-Based Replacement Fluid: Efficacy, Safety, and Impact on Nutrition. Am J Kidney Dis. 2005;46(5):908-918.
[17] KUO IY, EHRLICH BE. Signaling in muscle contraction. Cold Spring Harb Perspect Biol. 2015;7(2):a006023.
[18] HARVEY NC, BIVER E, KAUFMAN J, et al. The role of calcium supplementation in healthy musculoskeletal ageing : An expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF). Osteoporos Int. 2017;28(2):447-462.
[19] ANASTASIO AT, FARLEY KX, BODEN SD, et al. Modifiable, Postoperative Risk Factors for Delayed Discharge Following Total Knee Arthroplasty: The Influence of Hypotension and Opioid Use. J Arthroplasty. 2020; 35(1):82-88.
[20] TANG MJ, DING SB, HU WY. Fibrinogen and Albumin Score Changes during Preoperative Treatment Can Predict Prognosis in Patients with Locally Advanced Rectal Cancer. Gastroenterol Res Pract. 2019; 2019:3514586.
[21] LAI R, CHEN T, WU Z, et al. Associations between body mass index and mortality in acute-on-chronic liver failure patients. Ann Hepatol. 2019;18(6):893-897.
[22] UENO K, AJIKI T, TSUGAWA D, et al. Effectiveness of omega-3 fatty acid administration on completion rate of adjuvant chemotherapy for biliary tract cancer: study protocol for a single-centre, open-label, single-arm, historically controlled study. BMJ Open. 2019;9(8):e029915.
[23] OKAMOTO N, AMANO N, NAKAMURA T, et al. Relationship between tooth loss, low masticatory ability, and nutritional indices in the elderly: a cross-sectional study. BMC Oral Health. 2019;19(1):110.
[24] SŁOTWIŃSKI R, SARNECKA A, DĄBROWSKA A, et al. Innate immunity gene expression changes in critically ill patients with sepsis and disease-related malnutrition. Cent Eur J Immunol. 2015;40(3):311-324.
[25] HE Y, XIAO J, SHI Z, et al. Supplementation of enteral nutritional powder decreases surgical site infection, prosthetic joint infection, and readmission after hip arthroplasty in geriatric femoral neck fracture with hypoalbuminemia. J Orthop Surg Res. 2019;14(1):292.
[26] ALFARGIENY R, BODALAL Z, BENDARDAF R, et al. Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty. Avicenna J Med. 2015;5(4):117-122.
[27] KHANNA R, YI PH, SING DC, et al. Hypoalbuminemia Is Associated With Septic Revisions After Primary Surgery and Postoperative Infection After Revision Surgery. Spine (Phila Pa 1976). 2018;43(6):454-460.
[28] IBRAHIM MS, TWAIJ H, GIEBALY DE, et al. Enhanced recovery in total hip replacement: a clinical review. Bone Joint J. 2013;95-B(12):1587-1594.
[29] PEARSON TC, GUTHRIE DL, SIMPSON J, et al. Interpretation of measured red cell mass and plasma volume in adults: Expert Panel on Radionuclides of the International Council for Standardization in Haematology. Br J Haematol. 1995;89(4):748-756.
[30] GOOD L, PETERSON E, LISANDER B. Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement. Br J Anaesth. 2003;90(5):596-599.
[31] MARX G, SCHUERHOLZ T, PEDDER S, et al. Blood volume measurements using an integrated fiberoptic monitoring system in a porcine septic shock model. Crit Care Med. 2006;34:1483-1488.