title: Allogenic blood transfusion following total hip arthroplasty: results from the nationwide inpatient sample, 2000 to 2009.
abstract: BACKGROUND
  The large-scale utilization of allogenic blood transfusion and its associated outcomes have been described in critically ill patients and those undergoing high-risk cardiac surgery but not in patients undergoing elective total hip arthroplasty. The objective of this study was to determine the trends in utilization and outcomes of allogenic blood transfusion in patients undergoing primary total hip arthroplasty in the United States from 2000 to 2009.
  
  
  METHODS
  An observational cohort of 2,087,423 patients who underwent primary total hip arthroplasty from 2000 to 2009 was identified in the Nationwide Inpatient Sample. International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes 99.03 and 99.04 were used to identify patients who received allogenic blood products during their hospital stay. Risk factors for allogenic transfusions were identified with use of multivariable logistic regression models. We used propensity score matching to estimate the adjusted association between transfusion and surgical outcomes.
  
  
  RESULTS
  The rate of allogenic blood transfusion increased from 11.8% in 2000 to 19.0% in 2009. Patient-related risk factors for receiving an allogenic blood transfusion include an older age, female sex, black race, and Medicaid insurance. Hospital-related risk factors include rural location, smaller size, and non-academic status. After adjusting for confounders, allogenic blood transfusion was associated with a longer hospital stay (0.58 ± 0.02 day; p < 0.001), increased costs ($1731 ± $49 [in 2009 U.S. dollars]; p < 0.001), increased rate of discharge to an inpatient facility (odds ratio, 1.28; 95% confidence interval, 1.26 to 1.31), and worse surgical and medical outcomes. In-hospital mortality was not affected by allogenic blood transfusion (odds ratio, 0.97; 95% confidence interval, 0.77 to 1.21).
  
  
  CONCLUSIONS
  The increase in allogenic blood transfusion among total hip arthroplasty patients is concerning considering the associated increase in surgical complications and adverse events. The risk factors for transfusion and its impact on costs and inpatient outcomes can potentially be used to enhance patient care through optimizing preoperative discussions and effective utilization of blood-conservation methods.
authors.affiliation: Department of Orthopaedic Surgery, Mail Code A41, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail address for A.K. Klika: klikaa@ccf.org.
authors.forename: Anas
authors.initials: A
authors.lastname: Saleh
authors.affiliation: Department of Orthopaedic Surgery, Mail Code A41, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail address for A.K. Klika: klikaa@ccf.org.
authors.forename: Travis
authors.initials: T
authors.lastname: Small
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106.
authors.forename: Aiswarya Lekshmi Pillai
authors.initials: AL
authors.lastname: Chandran Pillai
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106.
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Schiltz
authors.affiliation: Department of Orthopaedic Surgery, Mail Code A41, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail address for A.K. Klika: klikaa@ccf.org.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Klika
authors.affiliation: Department of Orthopaedic Surgery, Mail Code A41, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail address for A.K. Klika: klikaa@ccf.org.
authors.forename: Wael K
authors.initials: WK
authors.lastname: Barsoum
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D016913:Blood Component Transfusion / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D012307:Risk Factors; D012423:Rural Health / Q000191:economics / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D014481:United States; D014504:Urban Health / Q000191:economics / Q000706:statistics & numerical data; D055815:Young Adult