Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty

C C Jørgensen; Ø Jans; H Kehlet; Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group

doi:10.1111/vox.12255

Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty

C C Jørgensen, Ø Jans, H Kehlet, Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group

Department of Clinical Medicine

4 Citations (Scopus)

Abstract

Background: Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered gastrointestinal (GI) cancer requiring further investigation. However, the association between preoperative anaemia and cancer 1 year after elective total hip (THA) and total knee arthroplasty (TKA) is unknown. We evaluated 1-year cancer diagnoses, particularly GI cancers, in anaemic and non-anaemic THA and TKA patients. Study Design and Methods: A prospective database on preoperative patient characteristics from six Danish orthopaedic centres was cross-referenced with the Danish Cancer Registry for information on diagnoses of new cancers 1 year after surgery. Crude cancer risk estimates were calculated using chi-square and Fisher's exact test in the total study cohort. Adjusted risk estimates were obtained using propensity scores and the Mantel-Haenzel statistic. Results: Of 5400 procedures, 731 (13·5%) were in anaemic patients. These were older and had more comorbidity than non-anaemic patients. There were 17 (2·3%) and 79 (1·6%) new cancers in anaemic and non-anaemic patients, respectively (OR: 1·38; 95% CI: 0·81-2·35, P = 0·228). After propensity matching of 661 anaemic and 1305 non-anaemic patients, we found no association between preoperative anaemia and cancer (OR: 0·94; 95% CI: 0·51-1·73, P = 0·837) or with GI cancers specifically (OR: 0·80; 95% CI: 0·25-2·56, P = 0·707). Conclusion: Preoperative anaemia per se may not be related to being diagnosed with cancer 1 year after THA and TKA. The optimal criteria for preoperative referral of anaemic patients to gastroenterologist in elective THA and TKA need further investigation.

Original language	English
Journal	Vox Sanguinis
Volume	109
Issue number	1
Pages (from-to)	62-70
Number of pages	9
ISSN	0042-9007
DOIs	https://doi.org/10.1111/vox.12255
Publication status	Published - 1 Jul 2015

Keywords

Aged
Aged, 80 and over
Anemia
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Blood Transfusion
Cohort Studies
Elective Surgical Procedures
Female
Humans
Male
Middle Aged
Neoplasms
Odds Ratio
Prospective Studies
Risk Factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1111/vox.12255

Cite this

@article{bc7e3de90ca84c679950658c1081556a,

title = "Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty",

abstract = "Background: Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered gastrointestinal (GI) cancer requiring further investigation. However, the association between preoperative anaemia and cancer 1 year after elective total hip (THA) and total knee arthroplasty (TKA) is unknown. We evaluated 1-year cancer diagnoses, particularly GI cancers, in anaemic and non-anaemic THA and TKA patients. Study Design and Methods: A prospective database on preoperative patient characteristics from six Danish orthopaedic centres was cross-referenced with the Danish Cancer Registry for information on diagnoses of new cancers 1 year after surgery. Crude cancer risk estimates were calculated using chi-square and Fisher's exact test in the total study cohort. Adjusted risk estimates were obtained using propensity scores and the Mantel-Haenzel statistic. Results: Of 5400 procedures, 731 (13·5%) were in anaemic patients. These were older and had more comorbidity than non-anaemic patients. There were 17 (2·3%) and 79 (1·6%) new cancers in anaemic and non-anaemic patients, respectively (OR: 1·38; 95% CI: 0·81-2·35, P = 0·228). After propensity matching of 661 anaemic and 1305 non-anaemic patients, we found no association between preoperative anaemia and cancer (OR: 0·94; 95% CI: 0·51-1·73, P = 0·837) or with GI cancers specifically (OR: 0·80; 95% CI: 0·25-2·56, P = 0·707). Conclusion: Preoperative anaemia per se may not be related to being diagnosed with cancer 1 year after THA and TKA. The optimal criteria for preoperative referral of anaemic patients to gastroenterologist in elective THA and TKA need further investigation.",

keywords = "Aged, Aged, 80 and over, Anemia, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Blood Transfusion, Cohort Studies, Elective Surgical Procedures, Female, Humans, Male, Middle Aged, Neoplasms, Odds Ratio, Prospective Studies, Risk Factors",

author = "J{\o}rgensen, {C C} and {\O} Jans and H Kehlet and {Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group}",

note = "{\textcopyright} 2015 International Society of Blood Transfusion.",

year = "2015",

month = jul,

day = "1",

doi = "10.1111/vox.12255",

language = "English",

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TY - JOUR

T1 - Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty

AU - Jørgensen, C C

AU - Jans, Ø

AU - Kehlet, H

AU - Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background: Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered gastrointestinal (GI) cancer requiring further investigation. However, the association between preoperative anaemia and cancer 1 year after elective total hip (THA) and total knee arthroplasty (TKA) is unknown. We evaluated 1-year cancer diagnoses, particularly GI cancers, in anaemic and non-anaemic THA and TKA patients. Study Design and Methods: A prospective database on preoperative patient characteristics from six Danish orthopaedic centres was cross-referenced with the Danish Cancer Registry for information on diagnoses of new cancers 1 year after surgery. Crude cancer risk estimates were calculated using chi-square and Fisher's exact test in the total study cohort. Adjusted risk estimates were obtained using propensity scores and the Mantel-Haenzel statistic. Results: Of 5400 procedures, 731 (13·5%) were in anaemic patients. These were older and had more comorbidity than non-anaemic patients. There were 17 (2·3%) and 79 (1·6%) new cancers in anaemic and non-anaemic patients, respectively (OR: 1·38; 95% CI: 0·81-2·35, P = 0·228). After propensity matching of 661 anaemic and 1305 non-anaemic patients, we found no association between preoperative anaemia and cancer (OR: 0·94; 95% CI: 0·51-1·73, P = 0·837) or with GI cancers specifically (OR: 0·80; 95% CI: 0·25-2·56, P = 0·707). Conclusion: Preoperative anaemia per se may not be related to being diagnosed with cancer 1 year after THA and TKA. The optimal criteria for preoperative referral of anaemic patients to gastroenterologist in elective THA and TKA need further investigation.

AB - Background: Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered gastrointestinal (GI) cancer requiring further investigation. However, the association between preoperative anaemia and cancer 1 year after elective total hip (THA) and total knee arthroplasty (TKA) is unknown. We evaluated 1-year cancer diagnoses, particularly GI cancers, in anaemic and non-anaemic THA and TKA patients. Study Design and Methods: A prospective database on preoperative patient characteristics from six Danish orthopaedic centres was cross-referenced with the Danish Cancer Registry for information on diagnoses of new cancers 1 year after surgery. Crude cancer risk estimates were calculated using chi-square and Fisher's exact test in the total study cohort. Adjusted risk estimates were obtained using propensity scores and the Mantel-Haenzel statistic. Results: Of 5400 procedures, 731 (13·5%) were in anaemic patients. These were older and had more comorbidity than non-anaemic patients. There were 17 (2·3%) and 79 (1·6%) new cancers in anaemic and non-anaemic patients, respectively (OR: 1·38; 95% CI: 0·81-2·35, P = 0·228). After propensity matching of 661 anaemic and 1305 non-anaemic patients, we found no association between preoperative anaemia and cancer (OR: 0·94; 95% CI: 0·51-1·73, P = 0·837) or with GI cancers specifically (OR: 0·80; 95% CI: 0·25-2·56, P = 0·707). Conclusion: Preoperative anaemia per se may not be related to being diagnosed with cancer 1 year after THA and TKA. The optimal criteria for preoperative referral of anaemic patients to gastroenterologist in elective THA and TKA need further investigation.

KW - Aged

KW - Aged, 80 and over

KW - Anemia

KW - Arthroplasty, Replacement, Hip

KW - Arthroplasty, Replacement, Knee

KW - Blood Transfusion

KW - Cohort Studies

KW - Elective Surgical Procedures

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasms

KW - Odds Ratio

KW - Prospective Studies

KW - Risk Factors

U2 - 10.1111/vox.12255

DO - 10.1111/vox.12255

M3 - Journal article

C2 - 25975629

SN - 0042-9007

VL - 109

SP - 62

EP - 70

JO - Vox Sanguinis

JF - Vox Sanguinis

IS - 1

ER -