title: Blood transfusion after total shoulder arthroplasty: Which patients are at high risk?
abstract: OBJECTIVE
  There are multiple reported risk factors and a wide range of reported blood transfusion rates for total shoulder arthroplasty (TSA). There are no evidence-based guidelines for blood transfusions in TSA patients.
  
  
  METHODS
  We utilized the Nationwide Inpatient Sample to analyze 51,191 patients undergoing TSA between 1998 and 2011. The purpose was to describe the incidence and identify the preoperative factors that are independently associated with blood transfusion after TSA. In addition, we studied the association of blood transfusions with certain variables such as length of stay (LOS), total charges, and payer status.
  
  
  RESULTS
  The blood transfusion rate in our study was 6.1%. There was no difference in the rate of blood transfusions over the study period (P < 0.001). In our logistic regression model, significant associations were found with increased age (odds ratio [OR] =1.03), white race (OR = 1.05), higher Charlson-Deyo score (OR = 1.12), presence of ischemic heart disease (OR = 1.24), blood loss anemia (OR = 1.65), female gender (OR = 1.94), presence of coagulation disorders (OR = 2.25), and presence of deficiency anemia (OR = 3.5). Patients receiving a blood transfusion had higher total charges, a longer hospital LOS, and were more likely to be Medicare payers (P < 0.001).
  
  
  CONCLUSIONS
  Our study found five clinically significant risk factors for blood transfusions for TSA: female gender, ischemic heart disease, deficiency anemia, coagulation disorder, and blood loss anemia. Patients with these risk factors should be considered higher risk for requiring a blood transfusion after TSA and counseled appropriately.
  
  
  METHODS
  Level II, retrospective cohort study, prognostic study.
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine and Shoulder Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA.
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Kandil
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine and Shoulder Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Griffin
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine and Shoulder Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Novicoff
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine and Shoulder Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Brockmeier
keywords: Allogeneic blood transfusion; autologous blood transfusion; complications; total shoulder arthroplasty