title: Transfusion after shoulder arthroplasty: an analysis of rates and risk factors.
abstract: OBJECTIVE
  Advancing age, lower preoperative hemoglobin levels, and more complex procedures are risk factors in transfusion requirements following shoulder arthroplasty.
  
  
  METHODS
  We retrospectively reviewed the records of 196 consecutive shoulder arthroplasties performed by a single surgeon (including 113 primary noncomplex total shoulder arthroplasties, 27 primary noncomplex hemiarthroplasties, 37 revision or complex arthroplasties, and 19 reverse shoulder arthroplasties). Logistic regression analysis was used to determine which clinical variables were associated with the need for postoperative transfusion.
  
  
  RESULTS
  The overall transfusion rate was 43% (84/196). The presence of preoperative anemia (males <13 g/dl, females <12 g/dl), decreasing preoperative hemoglobin levels, female gender, increasing age, and implantation of a reverse shoulder arthroplasty were independent risk factors for postoperative transfusion. Operative time, estimated blood loss, anesthesia type, preoperative use of anticoagulants and body mass index (BMI) were not found to be predictive of transfusion.
  
  
  CONCLUSIONS
  Our results corroborate the few existing studies regarding the effects of lower preoperative hemoglobin levels on transfusion risk following shoulder arthroplasty. In contrast to these studies, however, we found increasing age and the implantation of a reverse shoulder arthroplasty to be independent predictors for transfusion.
  
  
  CONCLUSIONS
  The results of the present study support close postoperative monitoring of older, female patients (>65 years), patients with preoperative anemia (males <13 g/dl, females <12 g/dl), and those undergoing reverse shoulder replacement. These patients should be educated before surgery of the potential need for postoperative blood transfusion.
  
  
  METHODS
  Level 4; Retrospective case series, no control group.
authors.affiliation: Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Konrad I
authors.initials: KI
authors.lastname: Gruson
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Accousti
authors.forename: Bradford O
authors.initials: BO
authors.lastname: Parsons
authors.forename: Gita
authors.initials: G
authors.lastname: Pillai
authors.forename: Evan L
authors.initials: EL
authors.lastname: Flatow
mesh_terms: D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000150:complications / Q000628:therapy; D019643:Arthroplasty, Replacement; D001803:Blood Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012785:Shoulder Joint / Q000601:surgery*; D065227:Transfusion Reaction
chemical_list: D006454:Hemoglobins