title: Blood management after total joint arthroplasty in the United States: 19-year trend analysis.
abstract: Recent studies have failed to show reductions in rates of red blood cell (RBC) transfusion after total joint arthroplasty (TJA) in the United States. This study aims to report the 19-year trend analysis of blood use in TJA, to determine predictors of RBC transfusion and association between RBC transfusion and in-hospital mortality after TJA using a nationally representative database.
  
  
  
  Nationwide inpatient sample (NIS) data from 1993 to 2011 were used. ICD-9-CM codes were used to identify TJA cases, RBC transfusion, autologous blood transfusion, and/or transfusion from cell salvage. Logistic regression analysis was performed to determine predictors of RBC transfusion and if transfusion increases risk of in-hospital mortality.
  
  
  
  A total of 2,225,054 TJA cases were identified. Using multivariate analysis, there was an increase in the rate of RBC transfusion over the study period (odds ratio [OR], 1.049; 95% confidence interval [CI], 1.048-1.050; p < 0.001). One-stage bilateral TJA (OR, 3.30; 95% CI, 3.24-3.37; p < 0.001), anemia due to chronic blood loss (OR, 2.69; 95% CI, 2.59-2.74, p < 0.001), deficiency anemia (OR, 2.59; 95% CI, 2.56-2.62; p < 0.001), and Charlson comorbidity index (OR, 1.24; 95% CI, 1.23-1.24; p < 0.001) were independent predictors of allogeneic blood transfusion. Transfusion of autologous blood reduced need for RBC transfusion (OR, 0.84; 95% CI, 0.82-0.85; p < 0.001). RBC transfusion was an independent predictor of in-hospital mortality (OR, 1.537; 95% CI, 1.395-1.694; p < 0.001).
  
  
  
  An increase in the rate of RBC use after TJA and the association between allogeneic blood transfusion and mortality are worrisome. Implementing more effective blood conservation strategies is recommended.
authors.affiliation: Rothman Institute of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania.|Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Rasouli
authors.affiliation: Rothman Institute of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Maltenfort
authors.affiliation: Rothman Institute of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Omer F
authors.initials: OF
authors.lastname: Erkocak
authors.affiliation: Rothman Institute of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Austin
authors.affiliation: Department of Anesthesiology and Bioengineering, University of Pittsburgh Medical Center.|McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Waters
authors.affiliation: Rothman Institute of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology / Q000628:therapy; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D016063:Blood Loss, Surgical; D017707:Erythrocyte Transfusion / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D044469:Racial Groups; D014481:United States