Plasma Fibrinogen as a Predictor of Perioperative-Blood-Component Transfusion in Major-Nontraumatic-Orthopedic-Surgery Patients: A Cohort Study

Diagnostics · 6 authors, 3 centres

AI SUMMARY

FIDELITY 100%

POPULATION195 patients aged ≥18 years undergoing primary or revision hip arthroplasty for nontraumatic etiologies.

INTERVENTIONPreoperative plasma fibrinogen measurement (cutoff <200 mg/dL).

COMPARISONPatients with fibrinogen ≥200 mg/dL.

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TL;DR

This prospective cohort study of 195 patients undergoing hip arthroplasty found no association between preoperative plasma fibrinogen levels and the need for perioperative blood transfusion. The study concludes that preoperative fibrinogen measurement is not an effective biomarker for predicting transfusion risk in this population.

Full summary

1,706 CHARS

BACKGROUND

Fibrinogen is a key coagulation factor, and low levels (<200 mg/dL) are associated with increased bleeding risk in some surgical populations. This study aimed to determine if preoperative fibrinogen levels predict perioperative blood transfusion in major nontraumatic orthopedic surgery. Methods: A prospective cohort study enrolled 195 patients undergoing hip arthroplasty or revision. Preoperative fibrinogen (Clauss method), blood counts, and coagulation tests were measured. The primary outcome was blood-product transfusion within 48 hours. Statistical analysis included chi-square, t-tests, and calculation of diagnostic test characteristics. Key Results: The mean preoperative fibrinogen was 315 (83) mg/dL. Only 13 patients (6.6%) had levels <200 mg/dL, and only one of them received a transfusion (absolute risk 7.69%). There was no statistically significant association between preoperative fibrinogen and transfusion need (p = 0.745). The sensitivity and positive predictive value of fibrinogen <200 mg/dL as a predictor were very low (4.17% and 7.69%, respectively). Preoperative hemoglobin and hematocrit were associated with transfusion rates. Limitations: This was a single-center observational study with a low prevalence of hypofibrinogenemia (6.6%), which may have reduced the positive predictive value. The study did not measure intraoperative bleeding volume. Implications: In this cohort of nontraumatic hip arthroplasty patients, preoperative plasma fibrinogen is not an effective biomarker for predicting perioperative blood transfusion. The findings suggest that routine preoperative fibrinogen measurement for transfusion risk assessment in this setting is unnecessary.

PICO

PPOPULATION

195 patients aged ≥18 years undergoing primary or revision hip arthroplasty for nontraumatic etiologies.

IINTERVENTION

Preoperative plasma fibrinogen measurement (cutoff <200 mg/dL).

OOUTCOME

Perioperative blood-product transfusion up to 48 hours after surgery.

STUDY TYPE

cohort

SPECIALTY

surgery

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10001368

Plasma Fibrinogen as a Predictor of Perioperative-Blood-Component Transfusion in Major-Nontraumatic-Orthopedic-Surgery Patients: A Cohort Study

Diagnostics

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ABSTRACT

There is a trend towards increased perioperative bleeding in patients with plasma fibrinogen levels < 200 mg/dL −1 . This study aimed to assess whether there is an association between preoperative fibrinogen levels and perioperative blood-product transfusion up to 48 h after major orthopedic surgery. This cohort study included 195 patients who underwent primary or revision hip arthroplasty for nontraumatic etiologies. Plasma fibrinogen, blood count, coagulation tests, and platelet count were measured preoperatively. A plasma fibrinogen level of 200 mg/dL −1 was the cutoff value used to predict blood transfusion. The mean (SD) plasma fibrinogen level was 325 (83) mg/dL −1 . Only thirteen patients had levels < 200 mg/dL −1 , and only one of them received a blood transfusion, with an absolute risk of 7.69% (1/13; 95%CI: 1.37–33.31%). Preoperative plasma fibrinogen levels were not associated with the need for blood transfusion ( p = 0.745). The sensitivity and the positive predictive value of plasma fibrinogen < 200 mg/dL −1 as a predictor of blood transfusion were 4.17% (95%CI: 0.11–21.12%) and 7.69% (95%CI: 1.12–37.99%), respectively. Test accuracy was 82.05% (95%CI: 75.93–87.17%), but positive and negative likelihood ratios were poor. Therefore, preoperative plasma fibrinogen level in hip-arthroplasty patients was not associated with the need for blood-product transfusion.

CITATION EXPORT

Eugenio Pagnussatt Neto, Paula Daniele Lopes da Costa, Sanderland J. Tavares Gurgel et al.. Plasma Fibrinogen as a Predictor of Perioperative-Blood-Component Transfusion in Major-Nontraumatic-Orthopedic-Surgery Patients: A Cohort Study. Diagnostics. (2023). https://doi.org/10.3390/diagnostics13050976

AUTHORS

6 · 3 CENTRES

Eugenio Pagnussatt Neto, Paula Daniele Lopes da Costa, Sanderland J. Tavares Gurgel, Paula Schmidt Azevedo, Norma S. Pinheiro Modolo, Paulo do Nascimento Junior

1Department of Surgical Specialties and Anesthesiology, School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu 18618-970, SP, Brazil
2São Vicente de Paulo Hospital, Passo Fundo 99010-112, RS, Brazil
3Department of Internal Medicine, School of Medicine, Universidade Estadual Paulista (UNESP), Botucatu 18618-970, SP, Brazil

EDITOR / REVIEWER

Tomoki Nakamura