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The Scientific World Journal
Volume 2014, Article ID 623460, 10 pages
http://dx.doi.org/10.1155/2014/623460
Research Article

Blood Transfusions in Total Hip and Knee Arthroplasty: An Analysis of Outcomes

1Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA
2Department of Public Health, Division of Biostatistics and Epidemiology, Weill Medical College of Cornell University, 402 East 67th Street, New York, NY 10065, USA
3Department of Anesthesiology, Perioperative Medicine and Critical Care Medicine, Paracelsus Medical University, Muellner Hauptstraße 48, 5020 Salzburg, Austria
4Department of Anesthesiology, Weill Medical College of Cornell University, 402 East 67th Street, New York, NY 10065, USA
5Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA

Received 23 August 2013; Accepted 22 October 2013; Published 21 January 2014

Academic Editors: R. Mascarenhas and W. R. Walsh

Copyright © 2014 Thomas Danninger et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Various studies have raised concern of worse outcomes in patients receiving blood transfusions perioperatively compared to those who do not. In this study we attempted to determine the proportion of perioperative complications in the orthopedic population attributable to the use of a blood transfusion. Methods. Data from 400 hospitals in the United States were used to identify patients undergoing total hip or knee arthroplasty (THA and TKA) from 2006 to 2010. Patient and health care demographics, as well as comorbidities and perioperative outcomes were compared. Multivariable logistic regression models were fitted to determine associations between transfusion, age, and comorbidities and various perioperative outcomes. Population attributable fraction (PAF) was determined to measure the proportion of outcome attributable to transfusion and other risk factors. Results. Of 530,089 patients, 18.93% received a blood transfusion during their hospitalization. Patients requiring blood transfusion were significantly older and showed a higher comorbidity burden. In addition, these patients had significantly higher rates of major complications and a longer length of hospitalization. The logistic regression models showed that transfused patients were more likely to have adverse health outcomes than nontransfused patients. However, patients who were older or had preexisting diseases carried a higher risk than use of a transfusion for these outcomes. The need for a blood transfusion explained 9.51% (95% CI 9.12–9.90) of all major complications. Conclusions. Advanced age and high comorbidity may be responsible for a higher proportion of adverse outcomes in THA and TKA patients than blood transfusions.