Risk Factors for Blood Transfusion After Primary Total Hip Arthroplasty
DOI:
https://doi.org/10.15438/rr.9.1.226Keywords:
joint replacement, hip arthroplasty, blood transfusion, hemoglobin testing, phlebotomyAbstract
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.
References
Kurtz, S., et al., Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. JBJS, 2007. 89(4): p. 780-785.
Zhi, M., et al., The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PloS one, 2013. 8(11): p. e78962.
Stuebing, E.A. and T.J. Miner, Surgical vampires and rising health care expenditure: reducing the cost of daily phlebotomy. Archives of Surgery, 2011. 146(5): p. 524-527.
May, T.A., et al., Reducing unnecessary inpatient laboratory testing in a teaching hospital. American journal of clinical pathology, 2006. 126(2): p. 200-206.
Hart, A., et al., Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. JBJS, 2014. 96(23): p. 1945-1951.
Holt, J.B., et al., Minimizing blood transfusion in total hip and knee arthroplasty through a multimodal approach. The Journal of arthroplasty, 2016. 31(2): p. 378-382.
Bedard, N.A., et al., Recent trends in blood utilization after primary hip and knee arthroplasty. The Journal of arthroplasty, 2017. 32(3): p. 724-727.
Martin, J.R., et al., Noninvasive Hemoglobin Monitoring: A Rapid, Reliable, and Cost-Effective Method Following Total Joint Replacement. JBJS, 2016. 98(5): p. 349-355.
Frew, N., et al., Impact of a blood management protocol on transfusion rates and outcomes following total hip and knee arthroplasty. The Annals of The Royal College of Surgeons of England, 2016. 98(6): p. 380-386.
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Kyle Kesler
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
