Patients with hemophilia who undergo elective orthopedic surgery may be at a higher risk of developing early wound postoperative complications if receiving inhibitor treatment and/or surgery for hemophilic pseudotumor, according to results of a study published in Haemophilia.
In this single-institution study, the investigators retrospectively evaluated medical records for 250 patients who were treated for hemophilic musculoskeletal conditions by elective orthopedic surgery. A total of 323 surgeries performed from 2002 through 2018 were included in the analysis. The main outcome was the incidence of postoperative wound complications in the first 30 days after surgery.
The mean patient age was 30.6 years and the majority of patients (89.6%) had hemophilia A, while a small number had hemophilia B (10.4%).
Postoperative wound complications within 30 days of surgery were reported in 24 patients; the incidence of wound complications was 7.4% across the population. Among patients who did not have preoperative infections, the incidence of wound complications was 6.5%. The most common presentations of early wound complications were superficial infections, dehiscence, skin necrosis, and persistent drainage.
For patients treated with inhibitors, the odds ratio (OR) for wound complications was 5.717 (95% CI, 1.08-30.3; P =.041) when evaluated through logistic regression analysis. For those patients who had undergone surgery for hemophilic pseudotumor, the OR for wound complications was 4.9 (95% CI, 1.3-18.5; P =.019).
Factor consumption on average across patients was 26.1 IU/kg/day. A total of 8 patients required vacuum sealing drainage, all of whom recovered. For patients with infections who received vacuum sealing drainage, there were nonsignificant trends toward higher values for factor consumption, duration of treatment, and total blood loss compared with those who did not have infections. Infectious complications were associated with more cycles of vacuum sealing drainage (P =.024).
The investigators suggested that patients with hemophilia may be at a greater risk for early wound complications following elective orthopedic surgery. The risk of wound complications seemed more pronounced in patients receiving inhibitors and in those receiving surgery for hemophilic pseudotumor. The investigators also concluded that vacuum sealing drainage appeared effective at treating refractory wound complications.
Feng B, Li Z, Feng C, et al. Early wound complications after orthopaedic surgery for haemophilia: what can we do more. Haemophilia. Published online August 1, 2020. doi:10.1111/hae.14113