Variation in Use of Blood Transfusion in Primary Total Hip and Knee Arthroplasties.
There is growing clinical and policy emphasis on minimizing transfusion use in elective joint arthroplasty, but little is known about the degree to which transfusion rates vary across US hospitals. This study aimed to assess hospital-level variation in use of allogeneic blood transfusion in patients undergoing elective joint arthroplasty and to characterize the extent to which variability is attributable to differences in patient and hospital characteristics.



The study population included 228,316 patients undergoing total knee arthroplasty (TKA) at 922 hospitals and 88,081 patients undergoing total hip arthroplasty (THA) at 606 hospitals from January 1, 2009 to December 31, 2011 in the Nationwide Inpatient Sample database, a 20% stratified sample of US community hospitals.



The median hospital transfusion rates were 11.0% (interquartile range, 3.5%-18.5%) in TKA and 15.9% (interquartile range, 5.4%-26.2%) in THA. After fully adjusting for patient- and hospital-related factors using mixed-effects logistic regression models, the average predicted probability of blood transfusion use in TKA was 6.3%, with 95% of the hospitals having a predicted probability between 0.37% and 55%. For THA, the average predicted probability of blood transfusion use was 9.5%, with 95% of the hospitals having a predicted probability between 0.57% and 66%. Hospital transfusion rates were inversely associated with hospital procedure volume and directly associated with length of stay.



The use of blood transfusion in elective joint arthroplasty varied widely across US hospitals, largely independent of patient case-mix and hospital characteristics.
Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, Massachusetts.
Mariano E
ME
Menendez
Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Rheumatology Allergy and Immunology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Na
N
Lu
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Krista F
KF
Huybrechts
Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas.
David
D
Ring
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
C Lowry
CL
Barnes
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Karim
K
Ladha
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Brian T
BT
Bateman
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003953:Diagnosis-Related Groups; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability
blood transfusion; policy; quality; total joint arthroplasty; variation