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2022, Vol. 26 ›› Issue (3): 376-382Correlation between blood loss during primary total knee arthroplasty and hypoalbuminemia and hypocalcemia after arthroplastyQu Pengfei, Wang Huisheng, Li Xi
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 |