Analysis of the incidence and risk factors of blood transfusion in total knee revision: a retrospective nationwide inpatient sample database study

Abstract

Objective: This study sought to determine the incidence and risk factors of blood transfusion among patients undergoing total knee revision (TKR) using a nationwide database.

Methods: A retrospective data analysis was conducted based on the Nationwide Inpatient Sample (NIS), enrolling patients who underwent TKR from 2010 to 2019 with complete information. The patients were divided into two groups based on whether they received blood transfusion or not. The demographic characteristics (race, sex, and age), length of stay (LOS), total charge of hospitalization, hospital characteristics (admission type, insurance type, bed size, teaching status, location, and region of hospital), hospital mortality, comorbidities, and perioperative complications were analyzed. Finally, we conducted univariate and multivariate logistic regression to identify factors that were associated with TKR patients to require blood transfusion.

Results: The NIS database included 115,072 patients who underwent TKR. Among them, 14,899 patients received blood transfusion, and the incidence of blood transfusion was 13.0%. There was a dramatic decrease in the incidence over the years from 2010 to 2019, dropping from 20.4 to 6.5%. TKR patients requiring transfusions had experienced longer LOS, incurred higher total medical expenses, utilized Medicare more frequently, and had increased in-hospital mortality rates (all P < 0.001). Independent predictors for blood transfusion included advanced age, female gender, iron-deficiency anemia, rheumatoid disease, chronic blood loss anemia, congestive heart failure, coagulopathy, uncomplicated diabetes, lymphoma, fluid and electrolyte disorders, metastatic carcinoma, other neurological diseases, paralysis, peripheral vascular disorders, pulmonary circulation disorders, renal failure, valvular disease, and weight loss. In addition, risk factors for transfusion in TKR surgery included sepsis, acute myocardial infarction, deep vein thrombosis, pulmonary embolism, gastrointestinal bleeding, heart failure, renal insufficiency, pneumonia, wound infection, lower limb nerve injury, hemorrhage/seroma/hematoma, wound rupture/non healing, urinary tract infection, acute renal failure, and postoperative delirium.

Conclusions: Our findings highlight the importance of recognizing the risk factors of blood transfusion in TKR to reduce the occurrence of adverse events.

Keywords: Blood transfusion; Incidence; Nationwide inpatient sample; Risk factors; Total knee revision.

Fig. 1

Exclusion process for patients undergoing total knee revision with blood transfusion

Fig. 2

Annual incidence of blood transfusion in total knee revision

Fig. 3

Patient demographics between the two surgical groups. A: Age distribution analysis of blood transfusion patients. B: Analysis of age distribution of patients without blood transfusion. C: Racial distribution analysis of blood transfusion patients. D: Racial distribution analysis of patients without blood transfusion

Fig. 4

Hospital characteristics between the two surgical groups. A: Analysis of the number of hospital beds for blood transfusion patients. B: Analysis of the number of hospital beds for patients without blood transfusion. C: Analysis of hospital regional distribution of blood transfusion patients. D: Analysis of hospital regional distribution of patients without blood transfusion

Fig. 5

Incidence of preoperative comorbidities related to blood transfusion

Fig. 6

Incidence of postoperative complications related to blood transfusion