title: Risk factors for blood transfusion after shoulder arthroplasty.
abstract: OBJECTIVE
  Currently, there is little information about the need for peri-operative blood transfusion in patients undergoing shoulder arthroplasty. The purpose of this study was to identify the rate of transfusion and its predisposing factors, and to establish a blood conservation strategy.
  
  
  METHODS
  We identified all patients who had undergone shoulder arthroplasty at our hospital between 1 January 2011 and 31 December 2013. The rate of transfusion was determined from the patient's records. While there were exceptions, patients typically underwent transfusion if they had a level of haemoglobin of < 7.5 g/dl if asymptomatic, < 9.0 g/dl if they had a significant cardiac history or symptoms of dizziness or light headedness. Multivariable regression analysis was undertaken to identify predictors of transfusion. High- and low-risk cohorts for transfusion were identified from a receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  Of 1174 shoulder arthroplasties performed on 1081 patients, 53 cases (4.5%) required transfusion post-operatively. Predictors of blood transfusion were a lower pre-operative haematocrit (p < 0.001) and shoulder arthroplasty undertaken for post-traumatic arthritis (p < 0.001). ROC analysis identified pre-operative haematocrit of 39.6% as a 90% sensitivity cut-off for transfusion. In total 48 of the 436 (11%) shoulder arthroplasties with a pre-operative haematocrit < 39.6% needed transfusion compared with five of the 738 (0.70%) shoulder arthroplasties with a haematocrit above this level.
  
  
  CONCLUSIONS
  We found that transfusion was needed less frequently than previously described for shoulder arthroplasty. Patients with a pre-operative haematocrit < 39.6% should be advised that there is an increased risk for blood transfusion, while those with a haematocrit above this level are unlikely to require transfusion.
  
  
  CONCLUSIONS
  The rate of transfusion after shoulder arthroplasty is under 5%, and those with a pre-operative haematocrit greater than or equal to 39.6% have a very low likelihood (< 1%) of requiring a transfusion.
authors: Thomas Jefferson University Hospital, 1025 Walnut Street, College Building, Room 516, Philadelphia, PA 19107, USA.
authors: E M
authors: EM
authors: Padegimas
authors: University at Buffalo, 462 Grider Street, Buffalo, NY 14215, USA.
authors: C T
authors: CT
authors: Clyde
authors: Thomas Jefferson University Hospital, 1025 Walnut Street, College Building, Room 516, Philadelphia, PA 19107, USA.
authors: B M
authors: BM
authors: Zmistowski
authors: The Rothman Institute-Thomas Jefferson University Hospital, 925 Chestnut St, 5th floor Philadelphia, PA 19107, USA.
authors: C
authors: C
authors: Restrepo
authors: The Rothman Institute-Thomas Jefferson University Hospital, 925 Chestnut St, 5th floor Philadelphia, PA 19107, USA.
authors: G R
authors: GR
authors: Williams
authors: The Rothman Institute-Thomas Jefferson University Hospital, 925 Chestnut St, 5th floor Philadelphia, PA 19107, USA.
authors: S
authors: S
authors: Namdari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data; D020878:Device Removal / Q000706:statistics & numerical data; D005260:Female; D006400:Hematocrit / Q000706:statistics & numerical data; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D012372:ROC Curve; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D000070636:Rotator Cuff Injuries; D055815:Young Adult
keywords: Shoulder arthroplasty; blood conservation; blood transfusion