Risk factors for postoperative blood transfusion after shoulder arthroplasty

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 total shoulder arthroplasty reverse total shoulder arthroplasty risk factors preoperative hemoglobin

Get full access to this article

View all access options for this article.

References

Adams

Sperling

Hoskin

, et al. Shoulder arthroplasty in Olmsted County, Minnesota, 1976-2000: a population-based study. J Shoulder Elbow Surg 2006; 15: 50–55.

Kim

Wise

Zhang

, et al. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am 2011; 93: 2249–2254.

Everhart

Bishop

Barlow

. Medical comorbidities and perioperative allogeneic red blood cell transfusion are risk factors for surgical site infection after shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26: 1922–1930.

Bohsali

Bois

Wirth

. Complications of shoulder arthroplasty. J Bone Joint Surg Am 2017; 99: 256–269.

Wirth

Rockwood

Jr . Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am 1996; 78: 603–616.

Bohsali

Wirth

Rockwood

Jr . Complications of total shoulder arthroplasty. J Bone Joint Surg Am 2006; 88: 2279–2292.

Malcherczyk

Abdelmoula

Heyse

, et al. Bleeding in primary shoulder arthroplasty. Arch Orthop Trauma Surg 2018; 138: 317–323.

Ceccherini-Nelli

Filipponi

Mosca

, et al. The risk of contracting an infectious disease from blood transfusion. Transplant Proc 2004; 36: 680–682.

Lemos

Healy

. Blood transfusion in orthopaedic operations. J Bone Joint Surg Am 1996; 78: 1260–1270.

10.

Bierbaum

Callaghan

Galante

, et al. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999; 81: 2–10.

11.

Pauzenberger

Domej

Heuberer

, et al. The effect of intravenous tranexamic acid on blood loss and early post-operative pain in total shoulder arthroplasty. Bone Joint J 2017; 99-B: 1073–1079.

12.

Cvetanovich

Fillingham

O'Brien

, et al. Tranexamic acid reduces blood loss after primary shoulder arthroplasty: a double-blind, placebo-controlled, prospective, randomized controlled trial. JSES Open Access 2018; 2: 23–27.

13.

Charles

Cvetanovich

Sumner-Parilla

, et al. Outpatient shoulder arthroplasty: outcomes, complications, and readmissions in 2 outpatient settings. J Shoulder Elbow Surg 2019; 28: S118–S123.

14.

Malcherczyk

Klasan

Ebbinghaus

, et al. Factors affecting blood loss and blood transfusion in patients with proximal humeral fractures. J Shoulder Elbow Surg 2019; 28: e165–e174.

15.

Schumer

Chae

Markert

, et al. Predicting transfusion in shoulder arthroplasty. J Shoulder Elbow Surg 2010; 19: 91–96.

16.

Hardy

Hung

Snow

, et al. Blood transfusion associated with shoulder arthroplasty. J Shoulder Elbow Surg 2013; 22: 233–239.

17.

Millett

Porramatikul

Chen

, et al. Analysis of transfusion predictors in shoulder arthroplasty. J Bone Joint Surg Am 2006; 88: 1223–1230.

18.

Malcherczyk

Hack

Klasan

, et al. Differences in total blood loss and transfusion rate between different indications for shoulder arthroplasty. Int Orthop 2019; 43: 653–658.

19.

Gruson

Accousti

Parsons

, et al. Transfusion after shoulder arthroplasty: an analysis of rates and risk factors. J Shoulder Elbow Surg 2009; 18: 225–230.

20.

Sperling

Duncan

Cofield

, et al. Incidence and risk factors for blood transfusion in shoulder arthroplasty. J Shoulder Elbow Surg 2005; 14: 599–601.

21.

King

Patrick

Schnetzer

, et al. Multivariate analysis of blood transfusion rates after shoulder arthroplasty. J Surg Orthop Adv 2017; 26: 40–47.

22.

Dacombe

Kendall

McCann

, et al. Blood transfusion rates following shoulder arthroplasty in a high volume UK centre and analysis of risk factors associated with transfusion. Shoulder Elbow 2019; 11: 67–72.

23.

Piper

Jacobson

Cofield

, et al. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol 2009; 47: 1878–1884.

24.

Garrigues

Zmistowski

Cooper

, et al. Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: the definition of periprosthetic shoulder infection. J Shoulder Elbow Surg 2019; 28: S8–S12.

25.

Kandil

Griffin

Novicoff

, et al.

Blood transfusion after total shoulder arthroplasty: which patients are at high risk?

Int J Shoulder Surg 2016; 10: 72–77.

26.

Padegimas

Clyde

Zmistowski

, et al. Risk factors for blood transfusion after shoulder arthroplasty. Bone Joint J 2016; 98-B: 224–228.

27.

Sharma

Tyler

. Transfusion of blood and blood products: indications and complications. Am Fam Physician 2011; 83: 719–724.

28.

Cappellini

Motta

. Anemia in clinical practice-definition and classification: does hemoglobin change with aging? Semin Hematol 2015; 52: 261–269.

29.

Anthony

Westermann

Gao

, et al. What are risk factors for 30-day morbidity and transfusion in total shoulder arthroplasty? A review of 1922 cases. Clin Orthop Relat Res 2015; 473: 2099–2105.

30.

Ryan

Yoshihara

Yoneoka

, et al. Blood transfusion in primary total shoulder arthroplasty: incidence, trends, and risk factors in the United States from 2000 to 2009. J Shoulder Elbow Surg 2015; 24: 760–765.