Analysis of complication rates following perioperative transfusion in shoulder arthroplasty.
BACKGROUND
Postoperative anemia requiring a blood transfusion is not uncommon following anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). However, the potential complications in patients undergoing transfusion after shoulder arthroplasty remain unclear. The goal of this study was to examine the postoperative outcomes of patients receiving blood transfusions following TSA and RTSA.


METHODS
Using the Medicare Standard Analytic Files database, we identified all patients undergoing TSA or RTSA between 2005 and 2010. Using International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology codes, we identified the procedure, transfusion status, comorbidities, and postoperative complications of interest. Odds ratios and 95% confidence intervals were calculated.


RESULTS
We identified 7,794 patients who received a perioperative blood transfusion following TSA or RTSA, as well as 34,293 age- and gender-matched controls, during the study period. Patients who received a perioperative transfusion had statistically significantly higher rates of myocardial infarction, pneumonia, systemic inflammatory response syndrome or sepsis, venous thromboembolic events, and cerebrovascular accidents at all time points in question. Patients who received a blood transfusion also showed an increased incidence of surgical complications, including periprosthetic infection and mechanical complications, up to 2 years postoperatively.


CONCLUSIONS
To our knowledge, this represents the largest study to examine the relationship between the need for perioperative blood transfusion and postoperative medical and surgical outcomes following TSA and RTSA. The results observed in this study highlight the importance of preoperative counseling and medical optimization prior to shoulder arthroplasty, particularly in patients with preoperative anemia or multiple medical comorbidities.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
A Jordan
AJ
Grier
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Abiram
A
Bala
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Colin T
CT
Penrose
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Thorsten M
TM
Seyler
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Michael P
MP
Bolognesi
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address: grant.garrigues@gmail.com.
Grant E
GE
Garrigues
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology*; D000072228:Arthroplasty, Replacement, Shoulder; D001803:Blood Transfusion; D016022:Case-Control Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies
Total; arthroplasty; complications; database; replacement; reverse; shoulder; transfusion