Journal Article10.2106/JBJS.N.00077
Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates.
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TL;DR: The authors did not find a strong association between perioperative red blood-cell transfusion and thirty-day incidences of infection, venous thromboembolism, or mortality; however, the odds of mortality were higher in patients who received a transfusion during total knee arthroplasty.
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Abstract: Background: The aim of this study was to analyze NSQIP (National Surgical Quality Improvement Program) data to better understand the incidence, risk factors, and thirty-day complication rates associated with transfusions in primary total hip and knee arthroplasty.
Methods: We identified 9362 total hip and 13,662 total knee arthroplasty procedures from the database and separated those in which any red blood-cell transfusion was performed within seventy-two hours after surgery from those with no transfusion. Patient demographics, comorbidities, preoperative laboratory values, intraoperative variables, and postoperative complications were compared between patients who received a transfusion and those who did not. Multivariate logistic regression was used to identify independent risk factors for receiving a transfusion as well as for associated postoperative complications (thirty-day incidences of infection, venous thromboembolism, and mortality).
Results: The transfusion rate after total hip arthroplasty was 22.2%. Significant risk factors for receiving a transfusion were age (OR [odds ratio] per ten years = 10.1), preoperative anemia (OR = 3.6), female sex (OR = 2.0), BMI (body mass index) of 2 (OR = 1.3). Multivariate logistic regression analysis indicated that adjusted odds of infection, venous thromboembolism, and mortality did not differ significantly between patients who received a transfusion and those who did not. The transfusion rate after total knee arthroplasty was 18.3%. Risk factors for receiving a transfusion were age (OR per ten years = 10.2), preoperative anemia (OR = 3.8), BMI of 2 (OR = 1.3). Multivariate logistic regression indicated that a transfusion was significantly associated with mortality (OR = 2.7) but not with infection or venous thromboembolism.
Conclusions: We did not find a strong association between perioperative red blood-cell transfusion and thirty-day incidences of infection, venous thromboembolism, or mortality; however, the odds of mortality were higher in patients who received a transfusion during total knee arthroplasty.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Citations
Nationwide Databases in Orthopaedic Surgery Research.
TL;DR: Nationwide databases offer large sample sizes, sampling of patients who are representative of the country as a whole, and data that enable investigation of trends over time, but readers should be aware of the differences between them and their limitations.
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Same-Day Discharge Compared with Inpatient Hospitalization Following Hip and Knee Arthroplasty.
TL;DR: No significant differences in overall postoperative complications or readmission were found between matched cohorts of patients who underwent same-day and inpatient hip and knee arthroplasties, although inpatients had a higher rate of thromboembolic events and same- day patients had aHigher rate of reoperation.
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Perioperative Allogeneic Red Blood-Cell Transfusion Associated with Surgical Site Infection After Total Hip and Knee Arthroplasty.
TL;DR: There was a dose-dependent relationship between allogeneic red blood-cell transfusion and SSI risk after total hip or knee arthroplasty, and the need for preoperative risk assessment, methods to limit surgical tissue injury, and optimized blood conservation strategies is underscore.
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Risk Factors for Blood Transfusion With Primary Posterior Lumbar Fusion.
Bryce A. Basques,Nidharshan S. Anandasivam,Matthew L. Webb,Andre M. Samuel,Adam M. Lukasiewicz,Daniel D. Bohl,Jonathan N. Grauer +6 more
TL;DR: 1 in 6 patients received a blood transfusion while undergoing primary posterior lumbar fusion, and risk factors for these occurrences were characterized, and strategies to minimize blood loss might be considered in these patients to avoid the associated complications.
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Incidence and Risk Factors for Blood Transfusion in Total Joint Arthroplasty: Analysis of a Statewide Database.
James D. Slover,Jessica A. Lavery,Ran Schwarzkopf,Richard Iorio,Joseph A. Bosco,Heather T. Gold +5 more
TL;DR: Primary hip arthroplasties have significantly greater risk of transfusion than knee arthroPLasties, and bilateral procedures have even greater risk, especially for hips.
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