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. 2013 Jul;9(2):123-8.
doi: 10.1007/s11420-013-9327-y. Epub 2013 Jun 21.

Blood utilization after primary total joint arthroplasty in a large hospital network

Antonia F Chen  1 , Brian A Klatt, Mark H Yazer, Jonathan H Waters
Affiliations

Blood utilization after primary total joint arthroplasty in a large hospital network

Antonia F Chen et al. HSS J. 2013 Jul.

Abstract

Background: Since a study in orthopedic hip fracture patients demonstrated that a liberal hemoglobin (Hb) threshold does not improve patient morbidity and mortality relative to a restrictive Hb threshold, the standard of care in total joint arthroplasty (TJA) should be examined to understand the variability of red blood cell (RBC) transfusion following TJA.

Questions/purposes: The study aimed to answer the following questions: (1) What is the blood utilization rate after primary TJA for individual surgeons within a large hospital network? (2) What is the comparison of hospital charges, length of stay (LOS), and discharge locations among TJA patients who were and were not transfused?

Methods: A retrospective study was conducted on 3,750 primary total knee arthroplasties (TKAs) and 2,070 primary total hip arthroplasties (THAs), and data was retrospectively collected over a 15-month period on the number of RBCs transfused per patient, along with demographic and cost details. The number of patients who received at least 1 RBC unit and the number of RBCs transfused per patient was calculated and stratified by surgeon.

Results: In the postoperative period, 19.3% TKA patients and 38.5% THA patients received a RBC transfusion. Transfusion rates following TJA varied widely between surgeons (TKA 4.8-63.8%, THA 4.3-86.8%). Transfused TKA patients received an average of 1.65 ± 0.03 RBCs, and THA patients received an average of 1.97 ± 0.14 RBCs. LOS and hospital charges for blood transfusion patients were higher than nontransfused patients.

Conclusion: Blood utilization after primary TJA varies greatly among surgeons, suggesting that resources may be misallocated. These findings highlight the need to standardize RBC transfusion practice following TJA.

Keywords: blood management; blood utilization; intervention; red blood cell (RBC) transfusion; total joint arthroplasty; transfusion rate.

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Figures

Fig. 1
Fig. 1
Flow chart describing the transfusion populations. a Total knee arthroplasty (TKA), b total hip arthroplasty (THA).
Fig. 2
Fig. 2
Comparison of individual surgeons by the relation of the number of cases performed during the study period, the transfusion rate, and the average number of units of red blood cells (RBCs) transfused per transfusion episode. The size of the circle is indicative of the number of cases performed per surgeon. The surgeon with the highest transfusion rate is indicated with a dashed arrow and the surgeon with the lowest transfusion rate is indicated with a solid arrow. a Total knee arthroplasty (TKA), b total hip arthroplasty (THA).
Fig. 3
Fig. 3
Discharge location. Primary a total knee arthroplasty (TKA) and b total hip arthroplasty (THA) patients who were not transfused were more likely to be discharged to home as opposed to a facility (skilled nursing facility, rehabilitation facility, etc.).
See this image and copyright information in PMC

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