Premium
Blood management after total joint arthroplasty in the U nited S tates: 19‐year trend analysis
Author(s) -
Rasouli Mohammad R.,
Maltenfort Mitchell G.,
Erkocak Omer F.,
Austin Mathew S.,
Waters Jonathan H.,
Parvizi Javad
Publication year - 2016
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13518
Subject(s) - medicine , odds ratio , confidence interval , blood transfusion , joint arthroplasty , anemia , red blood cell , blood management , comorbidity , hemoglobin , arthroplasty , surgery
BACKGROUND Recent studies have failed to show reductions in rates of red blood cell (RBC) transfusion after total joint arthroplasty (TJA) in the United States. This study aims to report the 19‐year trend analysis of blood use in TJA, to determine predictors of RBC transfusion and association between RBC transfusion and in‐hospital mortality after TJA using a nationally representative database. STUDY DESIGN AND METHODS Nationwide inpatient sample (NIS) data from 1993 to 2011 were used. ICD‐9‐CM codes were used to identify TJA cases, RBC transfusion, autologous blood transfusion, and/or transfusion from cell salvage. Logistic regression analysis was performed to determine predictors of RBC transfusion and if transfusion increases risk of in‐hospital mortality. RESULTS A total of 2,225,054 TJA cases were identified. Using multivariate analysis, there was an increase in the rate of RBC transfusion over the study period (odds ratio [OR], 1.049; 95% confidence interval [CI], 1.048‐1.050; p < 0.001). One‐stage bilateral TJA (OR, 3.30; 95% CI, 3.24‐3.37; p < 0.001), anemia due to chronic blood loss (OR, 2.69; 95% CI, 2.59‐2.74, p < 0.001), deficiency anemia (OR, 2.59; 95% CI, 2.56‐2.62; p < 0.001), and Charlson comorbidity index (OR, 1.24; 95% CI, 1.23‐1.24; p < 0.001) were independent predictors of allogeneic blood transfusion. Transfusion of autologous blood reduced need for RBC transfusion (OR, 0.84; 95% CI, 0.82‐0.85; p < 0.001). RBC transfusion was an independent predictor of in‐hospital mortality (OR, 1.537; 95% CI, 1.395‐1.694; p < 0.001). CONCLUSION An increase in the rate of RBC use after TJA and the association between allogeneic blood transfusion and mortality are worrisome. Implementing more effective blood conservation strategies is recommended.