title: Does Hemophilia Increase the Risk of Postoperative Blood Transfusion After Lower Extremity Total Joint Arthroplasty?
abstract: Hemophilia can lead to the development of arthropathies secondary to recurrent hemarthroses. However, given these patients' bleeding tendencies, postoperative complications associated with blood loss are a considerable concern.
  
  
  
  We identified men in the Nationwide Inpatient Sample who underwent total hip or knee arthroplasty between January 1998 and December 2010. We used propensity scores to match 332 hemophiliacs (267 hemophilia A, 65 hemophilia B) to a comparison cohort of 996 patients in a 1:3 ratio, according to the site of arthroplasty, year of admission, age, race, and Charlson and Deyo score.
  
  
  
  The incidence of any postoperative transfusion was 15.06% for hemophiliacs, compared with 9.84% for the matched comparison cohort (P = .012). For hemophiliacs, the odds ratio was 1.60 (95% confidence interval [CI] = 1.11-2.31; P = .013) for any transfusion, 1.90 (95% CI = 1.24-2.92; P = .003) for allogenic transfusion, and 1.05 (95% CI = 0.56-1.95; P = .888) for autogenic transfusion.
  
  
  
  Hemophilia is associated with an increased risk of blood transfusion after lower extremity total joint arthroplasty. Patients and providers should discuss these risks before surgery, and insurers should consider incorporating this comorbidity into bundled payments for total hip and knee arthroplasty.
authors: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
authors: Bhaveen H
authors: BH
authors: Kapadia
authors: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York; Department of Epidemiology and Biostatistics, SUNY Downstate Medical Center, Brooklyn, New York.
authors: Matthew R
authors: MR
authors: Boylan
authors: Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors: Randa K
authors: RK
authors: Elmallah
authors: Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors: Viktor E
authors: VE
authors: Krebs
authors: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.
authors: Carl B
authors: CB
authors: Paulino
authors: Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors: Michael A
authors: MA
authors: Mont
mesh_terms: D000368:Aged; 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; D006467:Hemophilia A / Q000150:complications*; D002836:Hemophilia B / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007596:Joints; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011184:Postoperative Period; D012306:Risk; D012307:Risk Factors; D014481:United States
keywords: bleeding; complication; hemophilia; total joint arthroplasty; transfusion