RISK FACTORS FOR POSTOPERATIVE BLOOD TRANSFUSION AFTER SHOULDER ARTHROPLASTY
Figure 1 - Details regarding patient selection, inclusion, and exclusion criteria. A total of 1211 shoulder arthroplasty cases were performed at a single institution, and 274 cases were ultimately included in this study. *Based on an a priori power analysis, the study authors determined that reviewing beyond 50 cases per indication would not be needed to identify differences in transfusion risk by surgical indication. **Shoulder arthroplasty for fracture, revision, and PJI were less commonly performed than arthroplasty for OA and cuff arthropathy, so the authors decided to review and analyze all available cases with these surgical indications.
OA: osteoarthritis; PJI: periprosthetic joint infection; SA: shoulder arthroplasty.
Purpose: To identify the effect of surgical indication, patient factors, and perioperative characteristics on transfusion after shoulder arthroplasty (SA).
Methods: Shoulder arthroplasties for osteoarthritis (OA) (N = 47), rotator cuff arthropathy (RCA) (N = 50), fracture (N = 76), revision (N = 66), and periprosthetic joint infection (PJI) (N = 35) performed at a single institution during a 6-year period were included. All other indications were excluded. Patient-based and surgical risk factors, including surgical indication, for postoperative allogeneic red blood cell transfusion were assessed with multivariate logistic regression analysis.
Results: A total of 274 SAs were included; transfusions were performed in 2% (2/97) of primary SAs for OA or RCA. Increased transfusion rates occurred in PJI (23%, p = 0.0006) and fracture (18%, p = 0.0018) cases. The mean preoperative hemoglobin (Hgb) was 12.2 ± 2.2 with PJI, 12.0 ± 2.1 with fracture, and 13.3 ± 1.6 g/dL for all other SAs. Independent risk factors for transfusion included lower preoperative hemoglobin (p < 0.001), PJI indication (p = 0.008), and fracture indication (p = 0.02), with no difference for fracture greater or less than 4 weeks old (p = 0.53).
Conclusion: Risk factors for allogeneic red blood cell transfusion after SA were low preoperative hemoglobin and procedures for PJI or fracture.
Level of Evidence: Level III, retrospective case-control study.
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Published January 20, 2021 in Shoulder & Elbow (Volume 14 - Issue 3).