Evidence map›Paper›PMID 35042718›Full record

ArticleCanadian journal of surgery. Journal canadien de chirurgie

Shape of the association between preoperative hemoglobin level and postoperative outcomes in patients undergoing primary arthroplasty.

George Grammatopoulos, Daniel I McIsaac, Paul E Beaulé, Carl van Walraven

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In one paragraph

Article in Canadian journal of surgery. Journal canadien de chirurgie. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

George GrammatopoulosFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Grammatopoulos, Beaulé); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Grammatopoulos, Beaulé); the Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ont. (McIsaac); the Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ont. (McIsaac, van Walraven); the Department of Epidemiology and Clinical Medicine, University of Ottawa, Ottawa, Ont. (McIsaac, van Walraven); and ICES, University of Ottawa, Ottawa, Ont. (van Walraven) ggrammatopoulos@toh.ca.
Daniel I McIsaacFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Grammatopoulos, Beaulé); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Grammatopoulos, Beaulé); the Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ont. (McIsaac); the Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ont. (McIsaac, van Walraven); the Department of Epidemiology and Clinical Medicine, University of Ottawa, Ottawa, Ont. (McIsaac, van Walraven); and ICES, University of Ottawa, Ottawa, Ont. (van Walraven).
Paul E BeauléFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Grammatopoulos, Beaulé); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Grammatopoulos, Beaulé); the Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ont. (McIsaac); the Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ont. (McIsaac, van Walraven); the Department of Epidemiology and Clinical Medicine, University of Ottawa, Ottawa, Ont. (McIsaac, van Walraven); and ICES, University of Ottawa, Ottawa, Ont. (van Walraven).
Carl van WalravenFrom the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Grammatopoulos, Beaulé); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Grammatopoulos, Beaulé); the Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ont. (McIsaac); the Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ont. (McIsaac, van Walraven); the Department of Epidemiology and Clinical Medicine, University of Ottawa, Ottawa, Ont. (McIsaac, van Walraven); and ICES, University of Ottawa, Ottawa, Ont. (van Walraven).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe shape of the association between preoperative hemoglobin level and outcomes after primary arthroplasty has not been adequately described. This study aimed to characterize the association between preoperative hemoglobin level and important outcomes after primary hip and knee arthroplasty and how this association is influenced by other key confounders.

methodsUsing de-identified, population-based health administrative data for Ontario housed at ICES, we identified all primary hip and knee arthroplasty procedures performed in Ontario between April 2007 and March 2017. Preoperative hemoglobin level, age, sex, Charlson Comorbidity Index score, American Society of Anesthesiologists score, preadmission living status, Hospital-patient One-year Mortality Risk (HOMR) score, and serum sodium and creatinine levels were extracted. All relevant postoperative outcomes that could be measured accurately were identified. We performed multivariable logistic regression and restricted cubic splines analyses.

resultsA total of 188 176 patients clustered within 532 surgeons were studied. The adjusted likelihood of transfusion increased notably and progressively when the preoperative hemoglobin level was below 135 g/L; duration of surgery, patient age and HOMR score amplified this association. Risk of postoperative admission to critical care showed a linear association with preoperative hemoglobin level. Risks of unplanned 30-day emergency department visit, 30-day readmission and 1-year all-cause mortality showed curvilinear associations with baseline hemoglobin level, with risks being notably greater as the level deviated from 137 g/L to 141 g/L.

conclusionPreoperative hemoglobin levels, both high and low, were independently significantly associated with primary arthroplasty outcomes, and levels at which outcome risks started to increase exceeded threshold values commonly used to define "normal." Preoperative hemoglobin level should be considered in future bundled payment models that aim to account for case-mix when grading postarthroplasty outcomes.

Indexed as

HemoglobinsAgedAged, 80 and overAge FactorsArthroplasty, Replacement, HipArthroplasty, Replacement, KneeBlood TransfusionFemaleHumansMaleMiddle AgedOntarioOutcome Assessment, Health CarePatient ReadmissionPostoperative ComplicationsPreoperative PeriodHemoglobins

Identifiers

PMID35042718
PMCPMC8900742

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.