Predictors and Complications of Blood Transfusion in Total Hip and Knee Arthroplasty

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Abstract

Perioperative patient optimization can minimize the need for blood transfusions in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to determine predictors and complications of transfusions. This retrospective review analyzed 1795 patients who underwent primary THA and TKA at our institution between January 2011 and December 2012. Of the 1573 patients ultimately included the rates of transfusion were 9.27% in TKA and 26.6% in THA. Significant predictors for transfusion include: preoperative hemoglobin, age, female gender, body mass index, creatinine, TKA, operating room time, operative blood loss, and intra-operative fluids. The DVT rate was comparable, but deep surgical site infection rate among transfused patients was 2.4% compared to 0.5% in non-transfused patients (P = 0.0065).

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Methods

Under institutional review board (IRB) approval, a retrospective chart review was performed of clinical records from 1795 patients who underwent THA or TKA at our institution between January 1, 2011 and December 31, 2012. Data were collected from 6 fellowship trained surgeons at 2 academically affiliated hospitals. Five independent reviewers collected all data and performed extensive chart reviews. After excluding patients who underwent bilateral procedure, partial arthroplasty or revision

Results

Currently there are a variety of criteria used for calculating preoperative risk for adverse cardiac and pulmonary events preoperatively, including the revised cardiac risk index (RCRI) and cardiopulmonary risk index. Rather than focusing on cumulative risk assessment, we focused on individual variables including: age, gender, BMI, pre-operative Hbg, and preoperative creatinine. The final study group was 66.3% female. The average age was 66.2 years [standard deviation (SD) = 10.71], BMI = 31.94 kg/m2

Discussion

Despite several studies reporting on transfusion rates in TKA and THA, there is substantial variability in reported rates. Rate for TKA ranges from 3 to 67% and for THA from 4 to 68% 2., 4., 7., 12., 13., 14., 15.. One reason for the extreme variability in transfusion rates may be associated with the relative lack of clear consensus regarding the appropriate indications for transfusion. At our institution, we transfuse patients who are symptomatic with hemoglobin less than 8 mg/dL and

Acknowledgments

The authors would like to thank Michael Laker, MD, Jason Davis, MD and Robert Weir, MD for their continued support of this project. Additionally we recognize the contributions of Ed Peterson, PhD, Christopher Dobson, BS, Jakub Sikora-Klak, BS, Alexander Greenstein, BS.

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The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.03.048.

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