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This retrospective study of 769 patients undergoing hip arthroplasty in Vietnam found a 41.1% prevalence of pre-operative anemia, which was independently associated with increased post-operative composite complications (37.6% vs 25.9%), infection complications (22.8% vs 11.2%), need for blood transfusions, and longer length of stay. Risk factors for pre-operative anemia included aging, BMI, creatinine levels, hip fracture, hyponatremia, and atrial fibrillation.
Pre-operative anemia is associated with significantly increased post-operative complications and resource utilization following hip arthroplasty in this Vietnamese cohort.
Background Managing pre-operative anemia is an essential element of the Enhanced Recovery After Surgery program. In developing nations, a high prevalence of pre-operative anemia and worse outcomes are predicted for patients undergoing hip arthroplasty. However, this area remains a significant research gap in these healthcare settings. Purpose The study aims to determine the prevalence, related factors, and outcomes of pre-operative anemia in hip arthroplasty patients. Methods This retrospective observational study used descriptive statistics to determine the prevalence of pre-operative anemia and employed multivariable logistic regression to identify its associated factors. Propensity score matching (PSM) was applied to reduce confounding before outcome comparisons, with inverse probability of treatment weighting (IPTW) used as a sensitivity analysis. The primary outcome was post-operative complications, with secondary and tertiary outcomes focusing on infection conditions, length of stay, clinical symptoms, and care demands. Results The study involved 769 patients, with a pre-operative anemia prevalence of 41.1%. Pre-operative factors related independently to anemia included aging, body mass index, creatinine levels, hip fractures, hyponatremia, and atrial fibrillation. After PSM, those with pre-operative anemia had significantly higher rates of post-operative composite complications (37.6% and 25.9%, p=0.017), infection complications (22.8% and 11.2%, p=0.003), urinary tract infections (10.2% and 3.6%, p=0.017), and sepsis (14.2% and 6.1%, p=0.012). Additionally, these patients experienced post-operative anemia (89.8% vs 74.6%, p<0.001), a higher need for blood transfusions (44.7% vs 10.7%, p<0.001), and a longer post-operative length of stay (7.2 vs 6.8 days, p<0.001). These findings remained consistent after IPTW adjustment. Conclusion In our setting, pre-operative anemia is highly prevalent among patients undergoing hip arthroplasty and is associated with adverse post-operative outcomes. Therefore, this study emphasizes the need to identify these patients as high risk for post-operative complications.
