Impact of Pre-Operative Anemia Severity on Primary Total Hip Arthroplasty Outcomes

Published:January 05, 2022DOI:



      Preoperative anemia (POA) is a significant predictor for adverse outcomes in primary total hip arthroplasty (THA). Current literature has studied POA stratified by severity. This study aims to find a threshold preoperative hemoglobin (Hb) value for increased risk of adverse outcomes in THA.


      This was a retrospective analysis of primary THA patients with preoperative Hb values from 2014-2021 from an academic orthopedic specialty hospital. Demographics, surgical data, and post-operative outcomes were collected. Patients without preoperative Hb values within the electronic health record (EHR) system or values acquired >30 days preoperatively were excluded. Patients were grouped based on POA severity using WHO criteria. Secondary analysis using discrete preoperative Hb values was performed. P-values were calculated using ANOVA/Kruskal-Wallis and chi-square/Fisher’s exact testing with p<0.05 considered significant.


      A total of 1,347 patients were included, 771(57.2%) patients with POA and 576(42.8%) with normal pre-operative Hb. In the POA group, 292(37.9%) were mild, 445(57.7%) moderate, and 34(4.4%) severe. Increased length of stay (LOS) was seen in moderate (3.9+4.3vs.2.4+2.1,p<0.001) and severe (5.0+3.4vs.2.4+2.1,p<0.0001) groups compared to control. The severe group had higher 90-day readmission and revision rates compared to control. Analysis by discrete Hb values showed increased LOS in Hb values <11g/dL and a greater proportion of patients with Hb values <12g/dL were discharged to skilled nursing facilities.


      Patients with preoperative Hb <12g/dL should be assessed for other risk factors that may predispose them to post-operative complications. Further investigation is warranted to develop more robust perioperative management strategies for POA patients undergoing THA.


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