title: Blood transfusion in primary total shoulder arthroplasty: incidence, trends, and risk factors in the United States from 2000 to 2009.
abstract: BACKGROUND
  Total shoulder arthroplasty (TSA) may be associated with substantial blood loss, and some patients require perioperative blood transfusion. Possible blood transfusion methods include predonated autologous blood transfusion, perioperative autologous blood transfusion, and allogeneic blood transfusion (ALBT). The purposes of the present study were to assess the incidence and recent trends over time of blood transfusion in TSA and analyze patient and hospital characteristics that affect the risk of ALBT.
  
  
  METHODS
  This study used national hospital discharge data from the National Inpatient Sample between 2000 and 2009. The data were used to generate the overall blood transfusion rate, and linear regression was used to assess trends in transfusion patterns over time. Logistic regression analysis was performed to analyze which patient and hospital characteristics independently influence the likelihood that a given patient undergoes ALBT.
  
  
  RESULTS
  The overall blood transfusion rate (ie, the proportion of patients who received at least 1 transfusion of any kind) was 6.7%. This rate increased over time, from 4.9% in 2000 to 7.1% in 2009 (P < .001). Risk factors associated with ALBT included age, gender, race, insurance status, hospital region, and hospital annual caseload.
  
  
  CONCLUSIONS
  The increase in overall blood transfusion rate in TSA found in the present study may be related to factors specific to TSA, such as the introduction of reverse total shoulder arthroplasty during the study period. A variety of patient and hospital characteristics contribute to the risk of undergoing ALBT.
authors: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA.
authors: Devon J
authors: DJ
authors: Ryan
authors: Department of Orthopaedic Surgery, Nassau University Medical Center, East Meadow, NY, USA; Department of Orthopaedic Surgery, State University of New York Downstate Medical Center, Brooklyn, NY, USA. Electronic address: hiroyoshihara55@yahoo.co.jp.
authors: Hiroyuki
authors: H
authors: Yoshihara
authors: Department of Statistical Science, School of Advanced Sciences, The Graduate University for Advanced Studies, Tachikawa, Tokyo, Japan.
authors: Daisuke
authors: D
authors: Yoneoka
authors: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA.
authors: Joseph D
authors: JD
authors: Zuckerman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data* / Q000639:trends; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data / Q000639:trends; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012785:Shoulder Joint / Q000601:surgery*; D014481:United States; D055815:Young Adult
keywords: National Inpatient Sample; Total shoulder arthroplasty; blood transfusion