Blood Transfusions in Total Hip and Knee Arthroplasty: An Analysis of Outcomes

Abstract

Background. Various studies have raised concern of worse outcomes in patients receiving blood transfusions perioperatively compared to those who do not. In this study we attempted to determine the proportion of perioperative complications in the orthopedic population attributable to the use of a blood transfusion. Methods. Data from 400 hospitals in the United States were used to identify patients undergoing total hip or knee arthroplasty (THA and TKA) from 2006 to 2010. Patient and health care demographics, as well as comorbidities and perioperative outcomes were compared. Multivariable logistic regression models were fitted to determine associations between transfusion, age, and comorbidities and various perioperative outcomes. Population attributable fraction (PAF) was determined to measure the proportion of outcome attributable to transfusion and other risk factors. Results. Of 530,089 patients, 18.93% received a blood transfusion during their hospitalization. Patients requiring blood transfusion were significantly older and showed a higher comorbidity burden. In addition, these patients had significantly higher rates of major complications and a longer length of hospitalization. The logistic regression models showed that transfused patients were more likely to have adverse health outcomes than nontransfused patients. However, patients who were older or had preexisting diseases carried a higher risk than use of a transfusion for these outcomes. The need for a blood transfusion explained 9.51% (95% CI 9.12–9.90) of all major complications. Conclusions. Advanced age and high comorbidity may be responsible for a higher proportion of adverse outcomes in THA and TKA patients than blood transfusions.

Blood management after total joint arthroplasty in the United States: 19‐year trend analysis

“…In this study, covering a longer period of time, we considered both primary and revision surgeries and performed multivariate analysis to adjust the rate of transfusion for a long list of variables including patient demographics, comorbidities, and use of autologous blood transfusion and cell salvage. Therefore, we believe that in contrast to the study by Yoshihara and Yoneoka, the rate of allogeneic blood transfusion is increasing nationwide, which is worrisome, as the adverse consequences of allogeneic blood transfusion in surgical patients are well known . In TJA patients, allogeneic blood transfusion particularly increases the risk of surgical site infection and periprosthetic joint infection .…”

“…Perioperative anemia is associated with blood transfusion in approximately 40% of cases . In addition to the potential complications of red blood cell (RBC) transfusion, including transmission of infectious diseases and transfusion‐related reactions, it has been shown that RBC transfusion compromises the outcome of TJA patients, prolongs hospital stay, and increases the risk of surgical site infection and mortality …”

Efficiency and Safety of Intravenous Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Systematic Review and Meta‐analysis

“…Substantial previous reports have shown that estimated total blood loss in patient undergoing unilateral TKA without antifibrinolytics ranges from 761 to 1784 mL and 7.7%–18.93% of these patients require transfusion. Obviously, bilateral TKA is more commonly associated with perioperative blood loss and associated with higher blood transfusion rates and number of units transfused than is unilateral TKA.…”

Perioperative blood transfusions

“…6 Danninger and colleagues reported an association between blood transfusions and adverse events in 530 089 patients undergoing major joint arthroplasty within the Premier Perspective dataset. 7 They concluded that the use of blood transfusions in this setting could explain 9.8% of all complications.…”