Analysis of independent risk factors for high hidden blood loss following total knee arthroplasty
- 1Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- 2Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, China
- 3School of Stomatology, Qingdao University, Qingdao, China
Abstract
Background: Hidden blood loss (HBL) constitutes a substantial proportion of total perioperative blood loss after total knee arthroplasty (TKA) and may adversely affect postoperative recovery, yet factors associated with high-level HBL remain insufficiently defined. This study aimed to investigate potential risk factors and the predictive value of high HBL following TKA. Methods: A retrospective cohort study was conducted at The Affiliated Hospital of Qingdao University. We included 154 patients undergoing primary unilateral TKA for knee osteoarthritis in 2024. Participants were categorized into low HBL (<654 mL) and high HBL (≥654 mL) groups. Data were analyzed using Student’s t-test, Mann-Whitney U test, and Chi-square test as appropriate. Multivariate binary logistic regression was performed to identify independent risk factors, with multicollinearity assessed via VIF. Predictive performance was evaluated using ROC curve analysis and further validated through 10-fold cross-validation in R. A two-sided P < 0.05 was considered statistically significant. Results: Body mass index (BMI) emerged as an independent risk factor for high HBL (OR = 1.306; 95% CI, 1.147–1.487; P < 0.001). Preexisting hypertension was also associated with increased risk (OR = 2.986; 95% CI, 1.278–6.974; P = 0.011). In predictive analyses, BMI demonstrated superior discriminative ability (AUC = 0.778) compared with hypertension (AUC = 0.622), with an optimal cut-off value of 26.34 kg/m². Conclusion: Elevated BMI (>26.34 kg/m²) was an independent predictor of high HBL following TKA, whereas preexisting hypertension represented an associated risk factor. Routine preoperative assessment of BMI could facilitate early identification of patients at high risk, enabling individualized perioperative blood management. Integrating BMI evaluation into surgical planning allowed clinicians to offer targeted weight optimization counseling and implement tailored blood-conservation strategies, ultimately reducing HBL and enhancing postoperative recovery and patient safety.
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BibTeX
@article{xu2026analysis,
title = {{Analysis of independent risk factors for high hidden blood loss following total knee arthroplasty}},
author = {Kaige Xu and Weipeng Shi and Tianyu Guo and Jiaqi Dong and Tianlong Gao and Yaping Jiang and Tao Li},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0356264},
url = {https://doi.org/10.1371/journal.pone.0356264},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Analysis of independent risk factors for high hidden blood loss following total knee arthroplasty
AU - Kaige Xu
AU - Weipeng Shi
AU - Tianyu Guo
AU - Jiaqi Dong
AU - Tianlong Gao
AU - Yaping Jiang
AU - Tao Li
PY - 2026
DA - 2026/09/03
JO - PLOS One
DO - 10.1371/journal.pone.0356264
UR - https://doi.org/10.1371/journal.pone.0356264
AB - Background: Hidden blood loss (HBL) constitutes a substantial proportion of total perioperative blood loss after total knee arthroplasty (TKA) and may adversely affect postoperative recovery, yet factors associated with high-level HBL remain insufficiently defined. This study aimed to investigate potential risk factors and the predictive value of high HBL following TKA. Methods: A retrospective cohort study was conducted at The Affiliated Hospital of Qingdao University. We included 154 patients undergoing primary unilateral TKA for knee osteoarthritis in 2024. Participants were categorized into low HBL (<654 mL) and high HBL (≥654 mL) groups. Data were analyzed using Student’s t-test, Mann-Whitney U test, and Chi-square test as appropriate. Multivariate binary logistic regression was performed to identify independent risk factors, with multicollinearity assessed via VIF. Predictive performance was evaluated using ROC curve analysis and further validated through 10-fold cross-validation in R. A two-sided P < 0.05 was considered statistically significant. Results: Body mass index (BMI) emerged as an independent risk factor for high HBL (OR = 1.306; 95% CI, 1.147–1.487; P < 0.001). Preexisting hypertension was also associated with increased risk (OR = 2.986; 95% CI, 1.278–6.974; P = 0.011). In predictive analyses, BMI demonstrated superior discriminative ability (AUC = 0.778) compared with hypertension (AUC = 0.622), with an optimal cut-off value of 26.34 kg/m². Conclusion: Elevated BMI (>26.34 kg/m²) was an independent predictor of high HBL following TKA, whereas preexisting hypertension represented an associated risk factor. Routine preoperative assessment of BMI could facilitate early identification of patients at high risk, enabling individualized perioperative blood management. Integrating BMI evaluation into surgical planning allowed clinicians to offer targeted weight optimization counseling and implement tailored blood-conservation strategies, ultimately reducing HBL and enhancing postoperative recovery and patient safety.
SN - 1932-6203
ER -