Impact of Perioperative Allogeneic and Autologous Blood Transfusion on Acute Wound Infection Following Total Knee and Total Hip Arthroplasty

Newman, Erik T.; Watters, Tyler Steven; Lewis, John S.; Jennings, Jason M.; Wellman, Samuel S.; Attarian, David E.; Grant, Stuart A.; Green, Cynthia L.; Vail, Thomas P.; Bolognesi, Michael P.

doi:10.2106/jbjs.l.01041

Cited by 134 publications

(89 citation statements)

References 20 publications

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“…Previous studies have found increased risk of surgical site infection after transfusion in orthopedic surgery, 27,33,35,36 including an increased risk of reoperation for infection after receiving transfusion preoperatively for adult THA. 34 In the current study, the only association of transfusion with SSI was an increased risk of superficial infection with large volume transfusion in the NM group; this association was not significant. The rarity of SSI in pediatric surgical populations likely limits the likelihood of finding any association.…”

Section: Discussioncontrasting

confidence: 58%

Blood Transfusion Incidence, Risk Factors, and Associated Complications in Surgical Treatment of Hip Dysplasia

Sherrod

Baker

Gilbert

2018

Journal of Pediatric Orthopaedics

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Background Perioperative bleeding requiring blood transfusion is a known complication of hip dysplasia (HD) surgery. Here we examine rates of, risk factors for, and postoperative complications associated with transfusion during HD surgery. Methods The National Surgical Quality Improvement Program (NSQIP) Pediatric database was queried for patients treated by an orthopedist from 2012-2013. HD cases were categorized by Current Procedural Terminology codes into femoral osteotomies, acetabular osteotomies, combined femoral/acetabular osteotomies, and open reductions. Patients were grouped by comorbidities: neuromuscular (NM) disease (e.g., Cerebral Palsy) group, non-NM with other comorbidity (Other) group, and no known comorbidity (NL) group. Patients were stratified by weight-normalized transfusion volume. Multivariate regression analysis of transfusion association with procedures, demographics, comorbidities, preoperative laboratory values, and 30-day complications was performed. Results A total of 1,184 HD cases were included. Transfusion rates for the NL, Other, and NM groups, respectively, were: 44/451 (9.8%), 61/216 (28.2%), and 161/517 (31.1%). Transfusion volumes (mean±SD) for the NL, Other, and NM groups, respectively, were: 8.4±5.4 mL/kg, 13.9±8.8 mL/kg, and 15.5±10.0 mL/kg (p<0.001).Combined osteotomies had the highest transfusion rates in the NM and Other groups (35.7% and 45.8%, respectively), whereas acetabular osteotomies had the highest rate in the NL group (15.8%). Open reductions had the lowest transfusion rate (all groups). Longer operations were independently associated with transfusion (all groups, per hour increase, OR>1.5, p<0.001). Independent patient risk factors included preoperative hematocrit <31% (NM group, OR=18.42, p=0.013), female gender (NL group, OR=3.55, p=0.008), developmental delay (NM group, OR=2.37, p=0.004), pulmonary comorbidity (NM group, OR=1.73, p=0.032), and older age (NL group, per year increase: OR=1.29, p<0.001). In all groups, transfusion was associated with longer hospitalization (p<0.001). We observed a volume-dependent increase in overall complication rate within the Other group for transfusion volumes >15 mL/kg (25.0% vs. 5.4% for <15 mL/kg, p=0.048). Conclusion We identified several risk factors for transfusion in HD surgery. The incidence of transfusion in HD surgery and its association with adverse outcomes warrants development of appropriate patient management guidelines. Level of Evidence Prognostic Level III

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Section: Discussioncontrasting

confidence: 58%

Blood Transfusion Incidence, Risk Factors, and Associated Complications in Surgical Treatment of Hip Dysplasia

Sherrod

Baker

Gilbert

2018

Journal of Pediatric Orthopaedics

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“…The use of autologous blood transfusion for elective orthopaedic surgery is decreasing, despite an overall upward trend in transfusion rates driven by an increase in allogeneic transfusions [7,45]. The decrease in this practice may be attributable to growing concerns regarding its cost-effectiveness and utility in patients without anemia [4,6,18,20], the possibility of iatrogenic anemia leading to increased overall transfusion rates [9,12,19], and some reports suggesting no differences regarding postoperative mortality and infection compared with allogeneic transfusions [9,30]. It therefore is possible that patients of higher socioeconomic status are asking for preoperative donation of blood to their own detriment, and, paradoxically, disadvantaged populations may not be receiving substandard care.…”

Section: Discussionmentioning

confidence: 99%

Minorities Are Less Likely to Receive Autologous Blood Transfusion for Major Elective Orthopaedic Surgery

Menendez

Ring

2014

Clinical Orthopaedics &Amp; Related Research

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Background Surgeons commonly arrange for patients to perform autologous blood donation before elective orthopaedic surgery. Understanding sociodemographic patterns of use of autologous blood transfusion can help improve quality of care and cost containment. Questions/purposes We sought to determine whether there were (1) racial disparities, (2) insurance-based disparities, or (3) income-based disparities in autologous blood use. Additionally, we evaluated the combined effect of (4) race and insurance and (5) race and income on autologous blood use, and we compared ratios of autologous with allogeneic blood use.

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“…The ASA classification system has been shown to be correlated with multiple factors that increase surgical resource utilization including infection [21], reoperations [22], intraoperative blood loss [23], and duration of surgery [24]. Similarly, hip fracture patients with a greater number of comorbidities have been shown to be more likely to suffer postoperative complications that would require diagnostics and imaging [25], which would explain the increase in radiology charges with ASA score.…”

Section: Discussionmentioning

confidence: 99%

Geriatric Hip Fractures and Inpatient Services: Predicting Hospital Charges Using the ASA Score

Thakore

Lee

Sathiyakumar

et al. 2014

Current Gerontology and Geriatrics Research

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Purpose. To determine if the American Society of Anesthesiologist (ASA) score can be used to predict hospital charges for inpatient services. Materials and Methods. A retrospective chart review was conducted at a level I trauma center on 547 patients over the age of 60 who presented with a hip fracture and required operative fixation. Hospital charges associated with inpatient and postoperative services were organized within six categories of care. Analysis of variance and a linear regression model were performed to compare preoperative ASA scores with charges and inpatient services. Results. Inpatient and postoperative charges and services were significantly associated with patients' ASA scores. Patients with an ASA score of 4 had the highest average inpatient charges of services of $15,555, compared to $10,923 for patients with an ASA score of 2. Patients with an ASA score of 4 had an average of 45.3 hospital services compared to 24.1 for patients with a score of 2. Conclusions. A patient's ASA score is associated with total and specific hospital charges related to inpatient services. The findings of this study will allow payers to identify the major cost drivers for inpatient services based on a hip fracture patient's preoperative physical status.

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Impact of Perioperative Allogeneic and Autologous Blood Transfusion on Acute Wound Infection Following Total Knee and Total Hip Arthroplasty

Cited by 134 publications

References 20 publications

Blood Transfusion Incidence, Risk Factors, and Associated Complications in Surgical Treatment of Hip Dysplasia

Blood Transfusion Incidence, Risk Factors, and Associated Complications in Surgical Treatment of Hip Dysplasia

Minorities Are Less Likely to Receive Autologous Blood Transfusion for Major Elective Orthopaedic Surgery

Geriatric Hip Fractures and Inpatient Services: Predicting Hospital Charges Using the ASA Score

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