Relative Risk Factors for Requirement of Blood Transfusion after Total Hip Arthroplasty (original) (raw)
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Blood transfusion following primary hip arthroplasty: a review of transfusion practice
European Journal of Orthopaedic Surgery & Traumatology, 2007
Aim The objective of the study is to assess blood transfusion practices in an orthopaedic unit in order to address the issue of high consumption of banked blood. Areas of weakness in current practice were identiWed and guidelines were produced to help reduce the consumption of allogenic blood. Materials and methods A retrospective audit of case notes and haematological records of 100 patients who had undergone primary total hip replacement (THR) was carried out. Results Ninety-three patients' case notes were available for review. Two groups of patients were identiWed: Transfusion group (N = 72) and Non-transfusion group (N = 21). A total of 170 units of blood were transfused postoperatively on the wards out of 277 cross-matched units, an utilisation rate of 61.3. 91.6% of units transfused were in pairs, with only 8.3% of units transfused given as single units. Conclusions Total hip arthroplasty can be safely performed without requiring blood transfusion in patients without co morbidity, or pre existing haematological disorder. Blood transfusion was higher in patients with a preoperative Hb level of less than 13 g/dl. Cross-matched blood need to be made available to patients in this group and the required units based on our review can be reduced from 4 to 2 in patients undergoing primary THR. A group and save is judged to be an adequate measure for patients with a pre-operative haemoglobin level of 13 g/dl or more.
The Journal of bone and joint surgery. American volume, 2004
The aim of this study was to identify clinical factors associated with an increased need for perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. We evaluated eighty-five consecutive nonanemic patients who underwent elective, unilateral, cementless, primary total hip arthroplasty and met our inclusion criteria. We attempted to determine whether clinical parameters influencing perioperative blood loss, such as age, gender, hypertension, and body mass index, were also associated with the need for perioperative blood transfusion. Perioperative blood transfusion was required in twenty-four (28%) of the eighty-five nonanemic patients. When considered alone, age, gender, hypertension, and body mass index were not significantly associated with an increased risk of perioperative blood transfusion, on the basis of the numbers available. In contrast, there was a significantly increased risk of blood transfusion when two or more of these clinical parameters ...
Transfusion Rates Are Increasing Following Total Hip Arthroplasty: Risk Factors and Outcomes
The Journal of Arthroplasty, 2013
Despite attempts to minimize exposure to allogeneic blood, there are little data on recent nationwide trends in transfusion following total hip arthroplasty (THA) and no consensus on indications. The purpose of this study was to examine the rate, predictors, and inpatient outcomes associated with transfusion after primary THA. This retrospective cohort study analyzed the data collected from US Nationwide Inpatient Sample (NIS) for each year during the period 2005-2008 to assess the trends in transfusion in patients who underwent elective primary THA. Logistic regression models were used to evaluate the predictive risk factors for blood transfusion. The University Hospital Consortium (UHC) database was also queried to examine the variability in rates of transfusion at different academic medical centers. A total of 129,901 patients were identified in the NIS database. The transfusion rates following THA consistently increased from 18.12% in 2005 to 21.21% in 2008 (P b 0.0001). Hospitals in the Northeast and Midwest region had the highest and lowest rates of transfusion, respectively. Significant risk factors for blood transfusion were female gender (odds ratio, OR 2.1), age above 85 (OR 2.9), African-American race (OR 1.7), Medicare payor status (OR 1.6), being at a hospital in the Northeast Region (OR 1.4), the presence of preoperative anemia (OR 1.6), having at least one comorbidity (OR 1.3), and a high Charlson Index score (OR 2.2). Patients receiving blood transfusions had increased inhospital mortality, longer lengths of stay, and higher total charges compared to non-transfused patients (P b 0.001). The UHC database demonstrated that transfusion rates vary widely across different institutions from b 5% to N 80%. The incidence of blood transfusion has recently increased following total hip arthroplasty and there is great variability in practice. We identified several patient risk factors along with the morbidity and mortality independently associated with transfusion following THA. Further work is needed to standardize the approach to blood conservation and minimize exposure to allogenic blood.
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 <30 kg/m(2) (OR = 1.4), and ASA (American Society of Anesthesiologists) class 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 <30 kg/m(2) (OR = 1.4), female sex (OR = 1.3), and ASA class 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.
The Journal of Bone and Joint Surgery, 2001
W e have assessed the effect of the donation of autologous blood and the preoperative level of haemoglobin on the prevalence of postoperative thromboembolism in 2043 patients who had a total hip arthroplasty. The level of haemoglobin was determined seven to ten days before surgery and all patients had venography of the operated leg on the fifth postoperative day. The number of patients who had donated autologous blood (1037) was similar to that who had not (1006). A significant decrease in the incidence of deep-vein thrombosis (DVT) was noted in those who had donated blood preoperatively (9.0%) compared with those who had not (13.5%) (p = 0.003). For all patients, the lower the preoperative level of haemoglobin the less likely it was that a postoperative DVT would develop.
Blood loss and transfusion rates following total hip arthroplasty: a multivariate analysis
Acta Orthopaedica Belgica
This study aimed to identify factors that inde- pendently predict increased rates of transfusion following total hip arthroplasty (THA) surgery. A retrospective analysis of all patients undergoing THA surgery over 12 months was performed. Electronic operative records were analysed to determine the following patient factors: American Society of Anesthesiologists (ASA) grade, body mass index (BMI), co-morbidities, indication for surgery, surgical technique, type of implant used, haematological markers, hospital length of stay (LOS) and complications. A total of 244 patients were included. There were 141 females (58%) and 103 males (42%). The median age was 65±12. The median pre-operative blood volume was 4500mls (IQR; 4000-5200). The median blood loss was 1069mls (IQR; 775-1390). The total number of patients requiring transfusion was 28 (11%), with a median of two units being transfused. Pre-operative haemoglobin (p<0.001) level, haematocrit (p<0.001) level and weight (p=0.016) ...
Transfusion Science, 1996
• Autologous blood transfusion {ABT) has become widely practiced as a useful procedure in preventing the side effects of allogeneic blood transfusion (allo-BT) and in coping with a cost-containment policy. We report on a retrospective analysis of blood support of 339 patients undergoing orthopedic elective surgery in the period 1988-1994. We observed a progressive decrease of allo-BTs {from 54.5 to 14.8% in males and from 73.7 to 15.5% in females undergoing total hip replacement), and assessed the usefulness of post-operative blood salvage in reducing the need for allo.BT when a concomitant pre-deposit program is conducted. In addition, we carefully reviewed charts in order to establish Deep Venous Thrombosis (DVT)-related morbidity, and found a surprisingly low incidence [only 3.2%) of this dreadful complication in our patient series. It is yet to be established whether anticoagulant prophylaxis and early mobilization are strongly effective in preventing
Blood Transfusions in Total Hip and Knee Arthroplasty: An Analysis of Outcomes
The Scientific World Journal, 2014
Background. Various studies have raised concern of worse outcomes in patients receiving blood transfusions perioperatively compared to those who do not. In this study we attempted to determine the proportion of perioperative complications in the orthopedic population attributable to the use of a blood transfusion. Methods. Data from 400 hospitals in the United States were used to identify patients undergoing total hip or knee arthroplasty (THA and TKA) from 2006 to 2010. Patient and health care demographics, as well as comorbidities and perioperative outcomes were compared. Multivariable logistic regression models were fitted to determine associations between transfusion, age, and comorbidities and various perioperative outcomes. Population attributable fraction (PAF) was determined to measure the proportion of outcome attributable to transfusion and other risk factors. Results. Of 530,089 patients, 18.93% received a blood transfusion during their hospitalization. Patients requiring blood transfusion were significantly older and showed a higher comorbidity burden. In addition, these patients had significantly higher rates of major complications and a longer length of hospitalization. The logistic regression models showed that transfused patients were more likely to have adverse health outcomes than nontransfused patients. However, patients who were older or had preexisting diseases carried a higher risk than use of a transfusion for these outcomes. The need for a blood transfusion explained 9.51% (95% CI 9.12-9.90) of all major complications. Conclusions. Advanced age and high comorbidity may be responsible for a higher proportion of adverse outcomes in THA and TKA patients than blood transfusions.
Hip international : the journal of clinical and experimental research on hip pathology and therapy, 2017
Although total hip arthroplasty (THA) is an effective treatment for end-stage arthritis, it is also associated with substantial blood loss that may require allogeneic blood transfusion. However, these transfusions may increase the risk of certain complications. The purpose of our study is to evaluate: (i) the incidence/trends of allogeneic blood transfusion; (ii) the associated risk factors and adverse events; and (iii) the discharge disposition, length of stay (LOS), and costs for these patients between 2009 and 2013. The National Inpatient Sample database was used to identify 1,542,366 primary THAs performed between 2009 and 2013. Patients were stratified based on demographics, economic data, hospital characteristics, comorbidities, and whether or not allogeneic transfusion was received. Logistic regression was performed to evaluate the risk factors for transfusion and postoperative complications. From 2009 to 2013, allogeneic transfusions were used in 16.9% of primary THAs, with ...
2017
Background: Allogenic blood transfusions are expensive and associated with risks and complications such as transmission of infections and incompatibility reactions. Aim: The objective of this study was to evaluate the efficacy of autologous blood transfusion in reducing the need for allogenic blood requirement after total hip replacement and also the cost benefit involved. Method: A retrospective case notes analysis of 178 consecutive patients undergoing total hip replacements from 2006 to 2007 were carried out. 73 patients belonged to Bellovac® ABT (Astra Tech) drains for post-operative blood salvage group (ABT group) and 105 patients belonged to standard Bellovac® (Astra Tech) vacuum drains group (Non-ABT group). Pre and post-operative haemoglobin (Hb) were compared between ABT and Non-ABT group in relation to type of surgery and anaesthesia. Results: 20 out of the 73 (27.3%) patients in ABT group and 45 out of 105 (42.8%) in Non-ABT group required blood transfusion (p=0.035). For...