Primary Joint Arthroplasty Surgery: Is the Risk of Major Bleeding Higher in Elderly Patients? A Retrospective Cohort Study

Increased risk of bleeding after major orthopedic surgery (MOS) has been widely documented in general population. However, this complication has not been studied in elderly patients. The purpose of this study is to determine whether the risk of major bleeding after MOS is higher in elderly patients, compared with those operated at a younger age. Methods: This retrospective cohort study included total hip and total knee arthroplasty patients operated during 5 consecutive years. The main outcome was the occurrence of major bleeding. Patients with other causes of bleeding were excluded. Relative risks (RRs) and confidence intervals (CIs) were calculated, anda multivariate analysis was performed. Results: A total of 1048 patients were included, 56% of patients were hip arthroplasties. At the time of surgery, 553 (53%) patients were older than 70 years. Patients aged >70 years showed an increased risk of major bleeding (RR: 2.42 [95% CI: 1.54-3.81]). For hip arthroplasty, the RR of bleeding was 2.61 (95%CI: 1.50-4.53) and 2.25 (95% CI: 1.03-4.94) for knee arthroplasty. After multivariate analysis, age was found to be independently associated with higher risk of major bleeding. Conclusion: According to European Medicines Agency criteria, patients aged 70 years are at a higher risk of major bleeding after MOS, result of a higher frequency of blood transfusions in this group of patients. Standardized protocols for blood transfusion in these patients are still required.

The voters of Colombia are free?

A fundamental principle of democracy is citizenship freedom. We suggest that a fair electoral contest is possible if a relationship between free will, electoral preferences and respect to the public institutions (constitutionalism) (section 1) exists. We focus on three illiberal practices that perturb the voter's decision: political clientelism and political markets (sections 2 to 4), media influence (which feeds on the voter's limited rationality and limited information) (section 5), and the suppression of opposition options (section 6). Later (section 8), we provide a brief balance and, additionally, we show how in Colombia the political system has missed opportunities to expand the voters' freedom. Our interpretation of the electoral process in Colombia is an appeal, supported on theoretical arguments and empirical evidence, to doubt about the voters' freedom. Also we make a call for more etudies.