Risk Factors for Blood Transfusion After Primary Total Hip Arthroplasty
Keywords:joint replacement, hip arthroplasty, blood transfusion, hemoglobin testing, phlebotomy
Aims: In the setting of rising healthcare costs, more cost efficiency in total hip arthroplasty (THA) is required. Following THA, most patients are monitored with serial hemoglobin testing despite few needing blood transfusions. This testing adds cost and may not be necessary in most patients. This study aims to identify factors associated with transfusion, therefore guiding hemoglobin monitoring following THA.
Patients and Methods: Patients who underwent primary THA in 2015 were identified using the National Surgical Quality Improvement Project (NSQIP) database. Patient discharged on the day of surgery were excluded. Patients were classified into those receiving transfusion versus no transfusion. Demographics and comorbidities were compared between groups followed by univariate and multivariate analysis, allowing identification of patient characteristics and comorbidities associated with transfusion.
Results: Overall, 28664 patients who underwent THA patients were identified. Within this group, 6.1% (n=1737) had a post-operative transfusion. Patients receiving a blood transfusion were older, had lower body mass index, and had higher rates of chronic obstructive pulmonary disease (COPD), heart failure, dialysis, prior transfusion, and were more frequently ASA class 3-4 (p<0.001). Univariate analysis demonstrated that patients requiring transfusion had higher complication rates (4.3% vs. 12.8%, p<0.0001). Multivariate analysis identified age >70, diabetes, smoking, COPD, prior transfusion, and operative time >2 hours as independent risk factors for transfusion.
Conclusion: Among THA patients, characteristics and comorbidities exist that are associated with increased likelihood of transfusion. Presence of these factors should guide hemoglobin monitoring post-operatively. Selective hemoglobin monitoring can potentially decrease the cost of THA.
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