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 (Kjeld Soeballe, Department of Orthopedics, Aarhus, Denmark; Torben B. Hansen, Department of Orthopedics, Holstebro, Denmark; Henrik Husted, Orthopedic Department, Hvidovre, Denmark; Mogens B. Laursen, Orthopedic Division, Aalborg, Denmark; Lars T. Hansen, MD, Orthopedic Department, Grindsted, Denmark; and Per Kjærsgaard-Andersen, Department of Orthopedics, Vejle, Denmark, members)

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 (Kjeld Soeballe, Department of Orthopedics, Aarhus, Denmark; Torben B. Hansen, Department of Orthopedics, Holstebro, Denmark; Henrik Husted, Orthopedic Department, Hvidovre, Denmark; Mogens B. Laursen, Orthopedic Division, Aalborg, Denmark; Lars T. Hansen, MD, Orthopedic Department, Grindsted, Denmark; and Per Kjærsgaard-Andersen, Department of Orthopedics, Vejle, Denmark, members)

6 Citationer (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.

Originalsprog	Engelsk
Tidsskrift	Vox Sanguinis
Vol/bind	109
Udgave nummer	1
Sider (fra-til)	62–70
Antal sider	9
ISSN	0042-9007
DOI	https://doi.org/10.1111/vox.12255
Status	Udgivet - 2015

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10.1111/vox.12255

Citationsformater

Jørgensen, C. C., Jans, Ø., Kehlet, H., & Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group (Kjeld Soeballe, Department of Orthopedics, Aarhus, Denmark; Torben B. Hansen, Department of Orthopedics, Holstebro, Denmark; Henrik Husted, Orthopedic Department, Hvidovre, Denmark; Mogens B. Laursen, Orthopedic Division, Aalborg, Denmark; Lars T. Hansen, MD, Orthopedic Department, Grindsted, Denmark; and Per Kjærsgaard-Andersen, Department of Orthopedics, Vejle, Denmark, members) (2015). Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty. Vox Sanguinis, 109(1), 62–70. https://doi.org/10.1111/vox.12255

Jørgensen, CC, Jans, Ø, Kehlet, H & Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group (Kjeld Soeballe, Department of Orthopedics, Aarhus, Denmark; Torben B. Hansen, Department of Orthopedics, Holstebro, Denmark; Henrik Husted, Orthopedic Department, Hvidovre, Denmark; Mogens B. Laursen, Orthopedic Division, Aalborg, Denmark; Lars T. Hansen, MD, Orthopedic Department, Grindsted, Denmark; and Per Kjærsgaard-Andersen, Department of Orthopedics, Vejle, Denmark, members) 2015, 'Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty', Vox Sanguinis, bind 109, nr. 1, s. 62–70. https://doi.org/10.1111/vox.12255

Jørgensen CC, Jans Ø, Kehlet H, Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group (Kjeld Soeballe, Department of Orthopedics, Aarhus, Denmark; Torben B. Hansen, Department of Orthopedics, Holstebro, Denmark; Henrik Husted, Orthopedic Department, Hvidovre, Denmark; Mogens B. Laursen, Orthopedic Division, Aalborg, Denmark; Lars T. Hansen, MD, Orthopedic Department, Grindsted, Denmark; and Per Kjærsgaard-Andersen, Department of Orthopedics, Vejle, Denmark, members). Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty. Vox Sanguinis. 2015;109(1):62–70. doi: 10.1111/vox.12255

@article{a6c49c671fa54deb894a8f4a77c7352c,

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.",

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 (Kjeld Soeballe, Department of Orthopedics, Aarhus, Denmark; Torben B. Hansen, Department of Orthopedics, Holstebro, Denmark; Henrik Husted, Orthopedic Department, Hvidovre, Denmark; Mogens B. Laursen, Orthopedic Division, Aalborg, Denmark; Lars T. Hansen, MD, Orthopedic Department, Grindsted, Denmark; and Per Kj{\ae}rsgaard-Andersen, Department of Orthopedics, Vejle, Denmark, members)} and Henrik Husted",

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

year = "2015",

doi = "10.1111/vox.12255",

language = "English",

volume = "109",

pages = "62–70",

journal = "Vox Sanguinis",

issn = "0042-9007",

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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 (Kjeld Soeballe, Department of Orthopedics, Aarhus, Denmark; Torben B. Hansen, Department of Orthopedics, Holstebro, Denmark; Henrik Husted, Orthopedic Department, Hvid

A2 - Husted, Henrik

PY - 2015

Y1 - 2015

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.

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 -

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

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