Risk Factors for Blood Transfusion After Primary Total Hip Arthroplasty


  • Kyle K. Kesler University of Iowa Hospitals and Clinics
  • Timothy S. Brown University of Iowa Hospital and Clinics
  • J. Ryan Martin OrthoCarolina
  • Bryan D. Springer OrthoCarolina
  • Jesse Otero University of Iowa Hospital and Clinics




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. 

Author Biographies

Kyle K. Kesler, University of Iowa Hospitals and Clinics


Timothy S. Brown, University of Iowa Hospital and Clinics


J. Ryan Martin, OrthoCarolina


Bryan D. Springer, OrthoCarolina


Jesse Otero, University of Iowa Hospital and Clinics



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.




How to Cite

Kesler, K. K., Brown, T. S., Martin, J. R., Springer, B. D., & Otero, J. (2019). Risk Factors for Blood Transfusion After Primary Total Hip Arthroplasty. Reconstructive Review, 9(1). https://doi.org/10.15438/rr.9.1.226



Original Article

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