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Archives of Orthopaedic and Trauma Surgery

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19-02-2021 | Orthopaedic Surgery

Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors

Authors: Hans-Christoph Erben, Florian Hess, JoEllen Welter, Nicole Graf, Marc P. Steurer, Thomas A. Neff, Ralph Zettl, Alexander Dullenkopf

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2022

Abstract

Introduction

Accurate identification of patients at risk of blood transfusion can reduce complications and improve institutional resource allocation. Probabilistic models are used to detect risk factors and formulate patient blood management strategies. Whether these predictors vary among institutions is unclear. We aimed to identify risk factors among our patients who underwent total hip (THA) or knee (TKA) arthroplasty, and combine these predictors to improve our model.

Materials and methods

We retrospectively assessed risk factors among 531 adults who underwent elective THA or TKA from January 2016 to November 2018. Using relevant surgical and patient characteristics gathered from electronic medical records, we conducted univariable and multivariable analyses. For our logistic regression model, we measured the impact of independent variables (age, gender, operation type (THA or TKA) and preoperative hemoglobin concentration) on the need for a transfusion.

Results

Of the 531 patients, 321 had THA (uncemented) and 210 had TKA. For the selected period, our transfusion rate of 8.1% (10.6% THA and 4.3% TKA) was low. Univariable analyses showed that lower BMI (p < 0.001) was associated with receiving a transfusion. Important factors identified through logistic regression analyses were age (estimated effect of an interquartile range increase in age: OR 3.89 [CI 95% 1.96–7.69]), TKA (OR − 0.77 [CI 95% − 1.57–0.02]), and preoperative hemoglobin levels (estimated effect of interquartile range increase in hemoglobin: OR 0.47 [CI 95% 0.31–0.71]). Contrary to findings from previous reports, gender was not associated with transfusion.

Conclusions

Previously published predictors such as advanced age, low preoperative hemoglobin, and procedure type (THA) were also identified in our analysis. However, gender was not a predictor, and BMI showed the potential to influence risk. We conclude that, when feasible, the determination of site-specific transfusion rates and combined risk factors can assist practitioners to customize care according to the needs of their patient population.

Level of evidence

Level 3, retrospective cohort study

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Title: Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors
Authors: Hans-Christoph Erben
Florian Hess
JoEllen Welter
Nicole Graf
Marc P. Steurer
Thomas A. Neff
Ralph Zettl
Alexander Dullenkopf
Publication date: 19-02-2021
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03763-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

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