Red Cell Distribution Width: An Unacknowledged Predictor of Mortality and Adverse Outcomes Following Revision Arthroplasty

Arash Aali-Rezaie; Pouya Alijanipour; Noam Shohat; Hamed Vahedi; Carol Foltz; Javad Parvizi

doi:10.1016/j.arth.2018.06.035

Red Cell Distribution Width: An Unacknowledged Predictor of Mortality and Adverse Outcomes Following Revision Arthroplasty

J Arthroplasty. 2018 Nov;33(11):3514-3519. doi: 10.1016/j.arth.2018.06.035. Epub 2018 Jul 4.

Authors

Arash Aali-Rezaie¹, Pouya Alijanipour², Noam Shohat³, Hamed Vahedi⁴, Carol Foltz¹, Javad Parvizi¹

Affiliations

¹ The Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
² Department of Orthopaedic Surgery, University of Miami, Miami, FL.
³ The Rothman Institute at Thomas Jefferson University, Philadelphia, PA; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁴ Department of Limb Lengthening and Reconstruction, Sinai Hospital, Baltimore, MD.

PMID: 30072185
DOI: 10.1016/j.arth.2018.06.035

Abstract

Background: Revision total joint arthroplasties (TJAs) have been empirically associated with significant postoperative morbidity and mortality. Red blood cell distribution width (RDW), a frequently measured hematological parameter, has been shown to predict mortality in hip fracture patients. However, its utility in risk-stratifying patients before revision TJA remains unknown. The aim of this study was to investigate the possible relationship between preoperative RDW levels and outcome of revision arthroplasty in terms of mortality, adverse outcomes, and length of hospital stay.

Methods: A single-institution retrospective study was conducted on 4633 patients who underwent revision TJA (3289 hips and 1344 knees) between 2000 and September 2016. Of those, 656 (14.1%) surgeries were performed due to periprosthetic joint infection, and 3977 (85.9%) were aseptic revisions. The association between preoperative RDW and various outcomes, including 1-year mortality, in-hospital medical complications, length of hospital stay, and 90-day all-cause readmission, was examined.

Results: The average age of patients in the cohort was 65.4 ± 12.9 years. The average Charlson comorbidity index was 0.6 (standard deviation = 1.0), with 691 patients (14.9%) having 2 or more comorbidities. Mean preoperative RDW level was 14.4% (standard deviation = 1.8). After adjusting for covariates, higher RDW levels were statistically significantly associated with mortality (adjusted odds ratio [OR], 1.25; 95% confidence interval [CI], 1.13-1.39; P < .001), any in-hospital medical complications (adjusted OR, 1.12; 95% CI, 1.07-1.18; P < .001), and readmission (adjusted OR, 1.07; 95% CI, 1.02-1.13; P < .001).

Conclusion: Higher levels of preoperative RDW appeared to be associated with less optimal outcomes after revision TJA. Adult reconstruction orthopedic surgeons should be aware of this predictive factor and exercise caution with TJA revision patients with high values of preoperative RDW. RDW could be included in the routine perioperative workup and used to counsel patients on their postoperative risk.

Keywords: complications; mortality; red cell distribution width; revision hip arthroplasty; revision knee arthroplasty.

MeSH terms

Aged
Arthritis, Infectious / etiology
Arthroplasty, Replacement, Hip / adverse effects
Arthroplasty, Replacement, Hip / mortality*
Arthroplasty, Replacement, Knee / adverse effects
Arthroplasty, Replacement, Knee / mortality*
Cohort Studies
Comorbidity
Erythrocyte Indices*
Female
Humans
Length of Stay
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Philadelphia / epidemiology
Postoperative Complications / blood*
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Reoperation / adverse effects
Reoperation / mortality*
Retrospective Studies