Risk factors for postoperative blood transfusion after shoulder arthroplasty

Kyle J Kopechek; Travis L Frantz; Joshua S Everhart; Richard Samade; Julie Y Bishop; Andrew S Neviaser; Gregory L Cvetanovich

doi:10.1177/1758573220982253

Risk factors for postoperative blood transfusion after shoulder arthroplasty

Shoulder Elbow. 2022 Jun;14(3):254-262. doi: 10.1177/1758573220982253. Epub 2021 Jan 20.

Authors

Kyle J Kopechek¹, Travis L Frantz¹, Joshua S Everhart¹, Richard Samade¹, Julie Y Bishop¹, Andrew S Neviaser¹, Gregory L Cvetanovich¹

Affiliation

¹ Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Abstract

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.

Keywords: Shoulder arthroplasty; postoperative blood transfusion; preoperative hemoglobin; reverse total shoulder arthroplasty; risk factors; total shoulder arthroplasty.