title: Blood transfusions in total hip and knee arthroplasty: an analysis of outcomes.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
authors.forename: Thomas
authors.identifier: 0000-0002-0933-5312
authors.initials: T
authors.lastname: Danninger
authors.affiliation: Department of Public Health, Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, 402 East 67th Street, New York, NY 10065, USA.
authors.forename: Rehana
authors.identifier: 0000-0001-7671-5430
authors.initials: R
authors.lastname: Rasul
authors.affiliation: Department of Public Health, Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, 402 East 67th Street, New York, NY 10065, USA.
authors.forename: Jashvant
authors.identifier: 0000-0001-7058-5102
authors.initials: J
authors.lastname: Poeran
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA ; Department of Anesthesiology, Perioperative Medicine and Critical Care Medicine, Paracelsus Medical University, Muellner Hauptstraße 48, 5020 Salzburg, Austria.
authors.forename: Ottokar
authors.identifier: 0000-0002-2718-9291
authors.initials: O
authors.lastname: Stundner
authors.affiliation: Department of Public Health, Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, 402 East 67th Street, New York, NY 10065, USA.
authors.forename: Madhu
authors.identifier: 0000-0002-3016-4263
authors.initials: M
authors.lastname: Mazumdar
authors.affiliation: Department of Anesthesiology, Weill Medical College of Cornell University, 402 East 67th Street, New York, NY 10065, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Fleischut
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
authors.forename: Lazaros
authors.initials: L
authors.lastname: Poultsides
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome