title: Postoperative anemia does not impede functional outcome and quality of life early after hip and knee arthroplasties.
abstract: BACKGROUND
  Clinicians have adopted a restrictive transfusion threshold (75-80 g/L) after major orthopedic surgery. Anemia may be associated with a decrease in postoperative vigor. We hypothesize that, in these patients, a threshold hemoglobin (Hb) concentration exists below which functional recovery and quality of life (QoL) become difficult.
  
  
  METHODS
  A prospective, observational cohort study in 305 patients 60 years or older undergoing a total hip or knee arthroplasty was conducted. Major outcome variables were distance walked in 6 minutes (6MWT), score on the Borg Scale for perception of effort, maximal dominant hand strength, and Short Form 36 (SF-36) QoL assessment in the preoperative and early postoperative periods. Patients were categorized according to their Hb level the day of the postoperative 6MWT (≤ 80, 81-90, 91-100, and >100 g/L).
  
  
  RESULTS
  There was no difference between Hb groups in the decrease of the distance walked preoperatively versus postoperatively. For both moments of observation, the 6MWT was not significantly different between Hb groups (p = 0.190). Similar results were found with perception of effort, maximal dominant hand strength, and SF-36 QoL assessment scores. In a regression model, the decrease in Hb concentration could explain only 1.9% of the total variation observed in the 6MWT (p = 0.008).
  
  
  CONCLUSIONS
  Moderate anemia is not associated with an impaired functional recovery or QoL in the immediate postoperative period after major arthroplasties. Further studies will be required to determine the long-term consequences of a restrictive transfusion strategy in these patients.
authors.affiliation: Department of Anesthesiology, CHUM Notre-Dame, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Elise
authors.initials: E
authors.lastname: Vuille-Lessard
authors.forename: Daniel
authors.initials: D
authors.lastname: Boudreault
authors.forename: François
authors.initials: F
authors.lastname: Girard
authors.forename: Monique
authors.initials: M
authors.lastname: Ruel
authors.forename: Miguel
authors.initials: M
authors.lastname: Chagnon
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Hardy
mesh_terms: D000368:Aged; D000465:Algorithms; D000740:Anemia / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation* / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D011788:Quality of Life; D016896:Treatment Outcome