Complication Data for Orthopedic Patients With Sickle Cell

One center’s experience with orthopedic patients with sickle cell disease did not match the experience as described in the literature. Since there is a paucity of data regarding orthopedic patients with sickle cell disease, this Boston Medical Center team took a fresh look at complication rates for orthopedic patients with sickle cell.

Their work, “Epidemiology and Perioperative Complications in Patients With Sickle Cell Disease After Orthopaedic Surgery: 26 Years’ Experience at a Major Academic Center,” appears in the December 1, 2019 edition of the Journal of the American Academy of Orthopaedic Surgeons.

Co-author Emily J. Curry, research project manager in the Department of Orthopaedic Surgery at Boston Medical Center in Massachusetts, explained the genesis of this study to OTW, “We first recognized that there was a paucity of literature that specifically examined perioperative complication rates in patients with sickle cell disease who had undergone orthopedic surgery. What literature that did exist cited complications rates that far exceeded what we had observed clinically—specifically our patients were not experiencing vasoocclusive events in the immediate postoperative period with the same frequency as other papers had reported.”

“Given that Boston Medical Center is one of the largest sickle cell disease centers in the Northeast, we wanted to evaluate our unique patient population to better understand if our clinical predictions in fact aligned with diminished perioperative complication rates, and if so, to offer any insight as to why that may be.”

The researchers conducted a retrospective chart review of all patients referred to their orthopedic surgery department between 1990 and 2016, for a total of 96 orthopedic surgeries. The authors wrote, “The majority of the patients with sickle cell disease were African American (90.3%) and women (60.4%). The most common surgical intervention was for hip osteonecrosis. Only 11.5% of the patients (11 of 96) experienced a perioperative complication, with the vasoocclusive event being the most common (7 patients; 64%).”

The authors described what they learned from the study to OTW, “Working together with pulmonologists and sickle cell disease experts, we demonstrated that, while not as common as previously reported, vasoocclusive events, particularly acute chest syndrome, are the main complications that orthopedic surgeons must be aware of.”

“As such, we recommend that orthopedic surgeons work closely with hematologists and anesthesiologists when coordinating care for these patients. While our work is still ongoing, we suggest that all patients have a preoperative hematology consult prior to surgery.”

“In addition, we recommend that for all patients with a hemoglobin less than 10 g/dL, they be transfused preoperatively so that their hemoglobin value falls above this threshold. We believe that these guidelines have contributed to the overall decreased complication rates we have observed in our patients.”