{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:18:38Z","timestamp":1787501918902,"version":"build-2736575974"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Advances in blood conservation have reduced the need for allogeneic transfusions in total knee and hip arthroplasty (TKA\/THA). This study aimed to assess whether perioperative bleeding complications, including hemorrhage\/hematoma, allogeneic transfusions, and postoperative anemia, occurred at similar rates between patients with hereditary bleeding disorders (BDs) and controls. Using a national health care database, we assessed the use of clotting factor concentrates (CFCs), perioperative outcomes, and resource utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted using the Premier Health Database (2017\u20132021) to analyze differences in outcomes and costs between 1528 patients with hereditary BDs and 20,509 non-BD controls undergoing elective TKA and THA. Summary statistics, bivariate analyses, and odds ratios (ORs) were used to evaluate perioperative outcomes and resource use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Patients with hereditary BDs were slightly younger, predominantly female, and more often treated at larger, urban hospitals compared to controls. Bleeding complications, including hemorrhage and hematoma, were infrequent but higher in the BD group (1.1% vs 0.2%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .0001). Transfusion rates were higher in THA than TKA, with significantly increased odds for patients with hereditary BD: for THA, OR 2.7 (95% confidence interval [CI], 2.0\u20133.7;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .0001); and for TKA, OR 2.6 (95% CI, 1.9\u20133.8;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .0001). CFC exposures occurred in 16.4% of patients with hereditary BD compared to 0.03% in controls. Of 270 reported CFC exposures, factor VIII (FVIII) and von Willebrand factor (VWF) were most commonly used (49.6% and 23.0%, respectively), followed by FIX concentrate (12.6%) and bypassing agents, including FVIIa (8.5%) and anti-inhibitor coagulant complex (AICC; 3.7%). Antifibrinolytic therapy was administered in most cases. Pharmacy costs for patients with hereditary BD were significantly higher, with a mean of $23,792 (95% CI, $8722\u2013$39,312), being over 30 times the mean cost in controls ($750; 95% CI, $739\u2013$762). Other outcomes were not different, except for a higher incidence of venous thromboembolism in the BD group (OR 3.9, 95% CI, 2.4\u20136.1;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>THA and TKA in patients with hereditary BDs are relatively safe, with most outcomes comparable to controls. However, higher rates of bleeding, transfusion, and VTE underscore the need for optimizing anemia management and targeted use of CFCs along with antifibrinolytic therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1213\/ane.0000000000007478","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T13:13:35Z","timestamp":1743772415000},"page":"1479-1487","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Bleeding Complications, Transfusion, and Acute Care Costs After Major Arthroplasty in Patients With Hereditary Bleeding Disorders: A National Healthcare Database Analysis"],"prefix":"10.1213","volume":"140","author":[{"given":"Kenneth E.","family":"Stewart","sequence":"first","affiliation":[{"name":"Departments of Surgery and Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee","family":"Pak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Kwak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra E.","family":"Hylton","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Mishima","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy L.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Rush Hemophilia and Thrombophilia Center, Chicago, Illinois."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi A.","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"R1-20251003","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.joca.2008.05.013","article-title":"Change in knee angle influences the rate of medial tibial cartilage volume loss in knee osteoarthritis.","volume":"17","author":"Teichtahl","year":"2009","journal-title":"Osteoarthritis Cartilage"},{"key":"R2-20251003","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.2106\/JBJS.21.01491","article-title":"A prospective, longitudinal study of the influence of obesity on total knee arthroplasty revision rate: results from the Australian Orthopaedic Association National Joint Replacement Registry.","volume":"104","author":"Wall","year":"2022","journal-title":"J Bone Joint Surg Am"},{"key":"R3-20251003","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","article-title":"Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.","volume":"89","author":"Kurtz","year":"2007","journal-title":"J Bone Joint Surg Am"},{"key":"R4-20251003","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1111\/hae.13236","article-title":"Differential effects of bleeds on the development of arthropathy\u2014basic and applied issues.","volume":"23","author":"van Vulpen","year":"2017","journal-title":"Haemophilia"},{"key":"R5-20251003","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/j.1423-0410.2012.01653.x","article-title":"Seventy-two total knee arthroplasties performed in patients with haemophilia using continuous infusion.","volume":"104","author":"Chevalier","year":"2013","journal-title":"Vox Sang"},{"key":"R6-20251003","doi-asserted-by":"crossref","first-page":"370","DOI":"10.5312\/wjo.v7.i6.370","article-title":"Orthopedic disorders of the knee in hemophilia: a current concept review.","volume":"7","author":"Rodriguez-Merchan","year":"2016","journal-title":"World J Orthop"},{"key":"R7-20251003","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/j.1365-2516.2007.01563.x","article-title":"Current approaches in haemophilic arthropathy of the hip.","volume":"15","author":"Mann","year":"2009","journal-title":"Haemophilia"},{"key":"R8-20251003","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1111\/jth.15654","article-title":"Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: a prospective multicenter observational study.","volume":"20","author":"Kleiboer","year":"2022","journal-title":"J Thromb Haemost"},{"key":"R9-20251003","doi-asserted-by":"crossref","first-page":"S369","DOI":"10.1016\/j.amepre.2011.09.008","article-title":"Overweight and obesity in hemophilia: a systematic review of the literature.","volume":"41","author":"Wong","year":"2011","journal-title":"Am J Prev Med"},{"key":"R10-20251003","doi-asserted-by":"crossref","first-page":"5256","DOI":"10.1182\/blood-2009-07-215665","article-title":"How I treat age-related morbidities in elderly persons with hemophilia.","volume":"114","author":"Mannucci","year":"2009","journal-title":"Blood"},{"key":"R11-20251003","doi-asserted-by":"crossref","DOI":"10.1177\/10760296231165056","article-title":"Perioperative outcomes of patients with bleeding disorders undergoing major surgery at an academic hemophilia treatment center.","volume":"29","author":"Rhoades","year":"2023","journal-title":"Clin Appl Thromb Hemost"},{"key":"R12-20251003","doi-asserted-by":"crossref","first-page":"102199","DOI":"10.1016\/j.rpth.2023.102199","article-title":"Surgery in rare bleeding disorders: the prospective MARACHI study.","volume":"7","author":"Rousseau","year":"2023","journal-title":"Res Pract Thromb Haemost"},{"key":"R13-20251003","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1097\/ALN.0000000000000120","article-title":"Inpatient falls after total knee arthroplasty: the role of anesthesia type and peripheral nerve blocks.","volume":"120","author":"Memtsoudis","year":"2014","journal-title":"Anesthesiology"},{"issue":"suppl 6","key":"R14-20251003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/hae.14046","article-title":"WFH guidelines for the management of hemophilia, 3rd edition.","volume":"26","author":"Srivastava","year":"2020","journal-title":"Haemophilia"},{"key":"R15-20251003","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1182\/bloodadvances.2020003264","article-title":"ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease.","volume":"5","author":"Connell","year":"2021","journal-title":"Blood Adv"},{"key":"R16-20251003","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/ALN.0000000000003772","article-title":"Safety of tranexamic acid in hip and knee arthroplasty in high-risk patients.","volume":"135","author":"Poeran","year":"2021","journal-title":"Anesthesiology"},{"key":"R17-20251003","doi-asserted-by":"crossref","first-page":"e561","DOI":"10.1097\/MPH.0000000000001904","article-title":"Bleeder with a clot: thrombosis following treatment of bleeding in a child with severe hemophilia B.","volume":"43","author":"Goh","year":"2021","journal-title":"J Pediatr Hematol Oncol"},{"key":"R18-20251003","doi-asserted-by":"crossref","first-page":"2178","DOI":"10.1053\/j.jvca.2020.02.013","article-title":"Clot formation in cardiopulmonary bypass circuit after application of factor XI concentrate.","volume":"34","author":"Hulsman","year":"2020","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"suppl 4","key":"R19-20251003","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/j.1745-6584.2005.0048.x","article-title":"Minimizing factor requirements for surgery without increased risk.","volume":"10","author":"Schulman","year":"2004","journal-title":"Haemophilia"},{"key":"R20-20251003","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1182\/bloodadvances.2018018226","article-title":"A cross-sectional analysis of cardiovascular disease in the hemophilia population.","volume":"2","author":"Sood","year":"2018","journal-title":"Blood Adv"},{"key":"R21-20251003","doi-asserted-by":"crossref","first-page":"2467","DOI":"10.1182\/blood-2003-05-1457","article-title":"Joint range-of-motion limitations among young males with hemophilia: prevalence and risk factors.","volume":"103","author":"Soucie","year":"2004","journal-title":"Blood"},{"key":"R22-20251003","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1213\/ANE.0000000000006036","article-title":"Relationships between body mass index, allogeneic transfusion, and surgical site infection after knee and hip arthroplasty surgery.","volume":"136","author":"Tanaka","year":"2023","journal-title":"Anesth Analg"},{"key":"R23-20251003","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1016\/j.jtha.2023.12.036","article-title":"Rates of venous thromboembolism and use of thromboprophylaxis after major orthopedic surgery in patients with congenital hemophilia A or B: a systematic review.","volume":"22","author":"Santagata","year":"2024","journal-title":"J Thromb Haemost"},{"key":"R24-20251003","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1056\/NEJMoa1712746","article-title":"Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty.","volume":"378","author":"Anderson","year":"2018","journal-title":"N Engl J Med"},{"key":"R25-20251003","doi-asserted-by":"crossref","first-page":"e2345883","DOI":"10.1001\/jamanetworkopen.2023.45883","article-title":"Venous thromboembolism in total hip and total knee arthroplasty.","volume":"6","author":"Simon","year":"2023","journal-title":"JAMA Netw Open"},{"key":"R26-20251003","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1111\/j.1538-7836.2010.03829.x","article-title":"Subclinical deep venous thrombosis observed in 10% of hemophilic patients undergoing major orthopedic surgery.","volume":"8","author":"Hermans","year":"2010","journal-title":"J Thromb Haemost"},{"key":"R27-20251003","doi-asserted-by":"crossref","first-page":"2471","DOI":"10.1182\/blood-2016-07-727032","article-title":"New concepts for anticoagulant therapy in persons with hemophilia.","volume":"128","author":"Schutgens","year":"2016","journal-title":"Blood"},{"key":"R28-20251003","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1046\/j.1365-2516.2002.00691.x","article-title":"Orthopaedic surgery in severe bleeding disorders: a low-volume, high-cost procedure.","volume":"8","author":"Mishra","year":"2002","journal-title":"Haemophilia"},{"key":"R29-20251003","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1111\/hae.13157","article-title":"Recombinant porcine factor VIII for high-risk surgery in paediatric congenital haemophilia A with high-titre inhibitor.","volume":"23","author":"Croteau","year":"2017","journal-title":"Haemophilia"},{"key":"R30-20251003","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/j.1537-2995.2009.02518.x","article-title":"Activity-based costs of blood transfusions in surgical patients at four hospitals.","volume":"50","author":"Shander","year":"2010","journal-title":"Transfusion"}],"container-title":["Anesthesia &amp; Analgesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1213\/ANE.0000000000007478","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:25:49Z","timestamp":1786112749000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1213\/ANE.0000000000007478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,4]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1213\/ane.0000000000007478","relation":{},"ISSN":["0003-2999","1526-7598"],"issn-type":[{"value":"0003-2999","type":"print"},{"value":"1526-7598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,4]]}}}