The incidence and risk factors for allogenic blood transfusion in total knee and hip arthroplasty

Abstract

Background Excessive blood loss in total joint arthroplasty (TJA) usually leads to an allogenic blood transfusion, which may cause adverse outcomes, prolonged length of hospitalization, and increased costs. The purpose of this study was to determine the incidence and risk factors for intraoperative and postoperative allogenic transfusion in patients undergoing primary unilateral total knee and hip arthroplasty (TKA and THA). Methods We conducted a retrospective study and enrolled consecutive patients undergoing primary unilateral TKA and THA at our institution between January 2010 and July 2014 ( n = 1534). Information about allogenic transfusion was collected from medical records to determine the incidence. We performed univariate analysis and multivariate logistic regression analysis to identify the independent risk factors. Results Total, intraoperative, and postoperative transfusion rates were 17.9%, 7.9%, and 11.3%, respectively. The preoperative lower level of hemoglobin (Hb) ( P < 0.001) and increased amount of intraoperative blood loss ( P < 0.001) were independently associated with transfusion in TKA. The independent risk factors for transfusion in THA were female ( P = 0.023), preoperative lower Hb level ( P < 0.001), prolonged operation time ( P < 0.001), and increased intraoperative blood loss ( P < 0.001). Conclusions Given the high prevalence and potential risk of transfusion in TJA, interventions for identified risk factors should be used during the perioperative period.

Development and validation of a nomogram to predict perioperative blood transfusion in patients undergoing total knee arthroplasty

“…Their relationship to transfusion has been extensively reported in previous studies. Preoperative Hb level is one of the most important predictors of postoperative transfusion in patients following TKA, for both unilateral or simultaneous bilateral TKA [1,2]. In addition, a recent study showed that preoperative Hb levels can still be used as an important predictor for postoperative transfusion in patients with TKA using antifibrinolytic drugs [15].…”

“…However, due to perioperative blood loss, some patients require allogenic blood transfusion after TKA. The reported incidence of transfusion varies from 3.5-29.1% in TKA patients [1][2][3]. Although blood transfusion can increase the hemoglobin level and improve postoperative recovery, it is an important risk factor for many catastrophic complications, such as deep venous thrombosis [4], surgical site infection [5], and periprosthetic joint infection [6].…”

The optimal regimen of oral tranexamic acid administration for primary total knee/hip replacement: a meta-analysis and narrative review of a randomized controlled trial

“…However, transfusion might result in the reaction of the immune system and increase the risk of infection, and several side effects have been reported in previous studies. Thus, there is an urgent need for an effective and safe method to help reduce blood loss during surgery [29,30].…”

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

“…65 years old, female gender, and BMI < 30. [23][24][25] Previous studies of various orthopaedic procedures have proposed that advanced age is a risk factor for blood transfusion, as decreased hematopoietic function of bone marrow and decreased platelet function can lead to increased blood loss. [26][27][28] In addition, physicians have traditionally used higher hemoglobin/hematocrit trigger points for transfusion in elderly patients.…”