title: Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates.
abstract: BACKGROUND
  The aim of this study was to analyze NSQIP (National Surgical Quality Improvement Program) data to better understand the incidence, risk factors, and thirty-day complication rates associated with transfusions in primary total hip and knee arthroplasty.
  
  
  METHODS
  We identified 9362 total hip and 13,662 total knee arthroplasty procedures from the database and separated those in which any red blood-cell transfusion was performed within seventy-two hours after surgery from those with no transfusion. Patient demographics, comorbidities, preoperative laboratory values, intraoperative variables, and postoperative complications were compared between patients who received a transfusion and those who did not. Multivariate logistic regression was used to identify independent risk factors for receiving a transfusion as well as for associated postoperative complications (thirty-day incidences of infection, venous thromboembolism, and mortality).
  
  
  RESULTS
  The transfusion rate after total hip arthroplasty was 22.2%. Significant risk factors for receiving a transfusion were age (OR [odds ratio] per ten years = 10.1), preoperative anemia (OR = 3.6), female sex (OR = 2.0), BMI (body mass index) of <30 kg/m(2) (OR = 1.4), and ASA (American Society of Anesthesiologists) class of >2 (OR = 1.3). Multivariate logistic regression analysis indicated that adjusted odds of infection, venous thromboembolism, and mortality did not differ significantly between patients who received a transfusion and those who did not. The transfusion rate after total knee arthroplasty was 18.3%. Risk factors for receiving a transfusion were age (OR per ten years = 10.2), preoperative anemia (OR = 3.8), BMI of <30 kg/m(2) (OR = 1.4), female sex (OR = 1.3), and ASA class of >2 (OR = 1.3). Multivariate logistic regression indicated that a transfusion was significantly associated with mortality (OR = 2.7) but not with infection or venous thromboembolism.
  
  
  CONCLUSIONS
  We did not find a strong association between perioperative red blood-cell transfusion and thirty-day incidences of infection, venous thromboembolism, or mortality; however, the odds of mortality were higher in patients who received a transfusion during total knee arthroplasty.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopedic Surgery, McGill University Health Centre, SMBD-Jewish General Hospital, Room E-003, 3755 Côte Ste-Catherine Road, Montréal, QC H3T 1E2, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Hart
authors.affiliation: Division of General Surgery, McGill University Health Centre, Royal Victoria Hospital, Room S10.26, 687 Pine Avenue West, Montréal, QC H3A 1A1, Canada.
authors.forename: Jad Abou
authors.initials: JA
authors.lastname: Khalil
authors.affiliation: Division of Orthopedic Surgery, McGill University Health Centre, SMBD-Jewish General Hospital, Room E-003, 3755 Côte Ste-Catherine Road, Montréal, QC H3T 1E2, Canada.
authors.forename: Alberto
authors.initials: A
authors.lastname: Carli
authors.affiliation: Division of Orthopedic Surgery, McGill University Health Centre, SMBD-Jewish General Hospital, Room E-003, 3755 Côte Ste-Catherine Road, Montréal, QC H3T 1E2, Canada.
authors.forename: Olga
authors.initials: O
authors.lastname: Huk
authors.affiliation: Division of Orthopedic Surgery, McGill University Health Centre, SMBD-Jewish General Hospital, Room E-003, 3755 Côte Ste-Catherine Road, Montréal, QC H3T 1E2, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Zukor
authors.affiliation: Division of Orthopedic Surgery, McGill University Health Centre, SMBD-Jewish General Hospital, Room E-003, 3755 Côte Ste-Catherine Road, Montréal, QC H3T 1E2, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Antoniou
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000009:adverse effects / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011182:Postoperative Care / Q000009:adverse effects / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012737:Sex Factors