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Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study.

ABSTRACT: BACKGROUND: Requirements for allogeneic red cell transfusion after total lower limb arthroplasty are still high (20-50%), and post-operative intravenous iron has been shown to reduce transfusion requirements for this surgery. We performed a cost analysis to ascertain whether this alternative is also likely to be cost-effective. MATERIALS AND METHODS: Data from 182 matched-pairs of total lower limb arthroplasty patients, managed with a restrictive transfusion protocol and without (control group) or with post-operative intravenous iron (iron group), were retrospectively reviewed. Acquisition and administration costs of iron (iron sucrose or ferric carboxymaltose) and allogeneic red cell concentrates, haemoglobin measurements, and prolonged stay in hospital were used for blood management cost analysis. RESULTS: Patients in the iron group received 600 mg intravenous iron, without clinically relevant incidents, and had a lower allogeneic transfusion rate (11.5% vs 26.4% for the iron and control groups, respectively; p=0.001). The reduction in transfusion rate was more pronounced in anaemic patients (17% vs 40%; p=0.015) than in non-anaemic ones (9.6% vs 21.2%; p=0.011). There were no differences with respect to post-operative infection rate. Patients receiving allogeneic transfusion stayed in hospital longer (+1.9 days [95% CI: 1.2-2.6]). As intravenous iron reduces the allogeneic transfusion rate, both iron formulations were cost-neutral in the different cost scenarios (-25.5 to 62.1 €/patient for iron sucrose, and -51.1 to 64.4 €/patient for ferric carboxymaltose). DISCUSSION: In patients presenting with or without pre-operative anaemia, post-operative intravenous iron after total lower limb arthroplasty seems to be safe and is associated with reduced transfusion rates, without incremental costs. For anaemic patients, its efficacy could be increased by associating some other blood-saving method.

SUBMITTER: Munoz M

PROVIDER: S-EPMC3926727 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study.

Muñoz Manuel M Gómez-Ramírez Susana S Martín-Montañez Elisa E Naveira Enrique E Seara Javier J Pavía José J

Blood transfusion = Trasfusione del sangue 20131003 1

<h4>Background</h4>Requirements for allogeneic red cell transfusion after total lower limb arthroplasty are still high (20-50%), and post-operative intravenous iron has been shown to reduce transfusion requirements for this surgery. We performed a cost analysis to ascertain whether this alternative is also likely to be cost-effective.<h4>Materials and methods</h4>Data from 182 matched-pairs of total lower limb arthroplasty patients, managed with a restrictive transfusion protocol and without (co ...[more]

PMID: 24120595

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Project description:Gout is the most prevalent form of inflammatory arthritis in the world. Total hip arthroplasty (THA) has emerged as a widely sought-after and highly effective surgical procedure for advanced hip diseases. However, there is a lack of research on the impact of gout on primary THA outcomes in large cohorts. This study aimed to address this gap by primarily investigating complications following THA in patients with or without gout. Patients with records of gout in the 2 years leading up to their primary THA and who also have at least 2 years of follow-up were identified using a national insurance database and compared to a 5:1 matched control. A total of 32,466 patients with gout and 161,514 patients without gout undergoing THA were identified. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to 2 years. In addition, 90-day emergency department (ED) visits and inpatient readmission were also documented. Patients with gout demonstrated higher rates of medical complications including deep vein thrombosis, transfusion, acute kidney injury, and urinary tract infection than non-gout patients (p < 0.001). Gout patients also showed higher rates of pulmonary embolism (p = 0.017). Increased incidences of surgical complications were identified in gout patients, specifically wound complications and periprosthetic joint infection (p < 0.001). There was an increased risk of revision for gout patients up to 90 days (p = 0.003), 1 year (p = 0.027), and 2 years (p = 0.039). There was also an increased risk of dislocation for gout patients up to 90 days (p = 0.022) and 1 year (p = 0.047), but not at 2 years. No significant difference was observed in aseptic loosening or periprosthetic fracture. Additionally, gout patients also demonstrated a higher likelihood of 90-day ED visits and readmission (p < 0.001). Primary THA in gout patients is associated with increased risks of multiple medical and surgical complications. Our findings provide insights into the planning and expectation of THA for patients with gout. These insights have the potential to benefit the decision-making process for gout patients considering THA.

Project description:AimThe objective of the study is to compare the accuracy of implant positioning and limb alignment achieved in robotic-arm assisted total knee arthroplasty(RATKA) and manual total knee arthroplasty(MTKA) to their respective preoperative plan.Patients and methodsThis was a prospective observational study conducted in a tertiary care centre between August 2018 and January 2020. 143 consecutive RATKA(105 patients) and 151 consecutive MTKA(111 patients) performed by two experienced arthroplasty surgeons were included. Two independent observers evaluated the accuracy of implant positioning by measuring the radiological parameters according to the Knee-Society-Roentgenographic-Evaluation-System and limb alignment from postoperative weight-bearing scanogram. Outcomes were defined, based on the degree of deviation of measurements from the planned position and alignment, as excellent(0-1.99°), acceptable(2.00-2.99°) and outlier(≥ 3.00°).ResultsThere were no systematic differences in the demographic and baseline characteristics between RATKA and MTKA. Statistically significant outcomes were observed favouring robotic group for postoperative mechanical axis (p < .001), coronal inclination of the femoral component (p < 0.001), coronal inclination of tibial component (p < 0.001), and sagittal inclination of tibial component (p < 0.001). There was no significant difference in the sagittal inclination of the femoral component (p = 0.566). The percentage of knees in the 'excellent' group were higher in RATKA compared to MTKA. There was absolutely no outlier in terms of limb alignment in the RATKA group versus 23.8% (p < 0.001) in the MTKA group. All the measurements showed high interobserver and intraobserver reliability.ConclusionRobotic-arm assisted TKA executed the preoperative plan more accurately with respect to limb alignment and implant positioning compared to manual TKA, even when the surgeons were more experienced in the latter.Graphic abstractSupplementary informationThe online version contains supplementary material available at 10.1007/s43465-020-00324-y.

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Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study.

Publications

Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study.

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