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. 2025 Mar 21;145(1):206.
doi: 10.1007/s00402-025-05823-x.

Trends, risk factors, and complications of blood transfusion in primary total knee arthroplasty in China: a nationwide retrospective study

Qiao Jiang #  1 , Fanqiang Meng #  1 , Liusong Shen  1 , Junzhi Sheng  1 , Dongxing Xie  1   2   3 , Xiang Ding  4   5   6
Affiliations

Trends, risk factors, and complications of blood transfusion in primary total knee arthroplasty in China: a nationwide retrospective study

Qiao Jiang et al. Arch Orthop Trauma Surg. .

Abstract

Introduction: Identifying risk factors and prognosis associated with red blood cell (RBC) transfusions will be meaningful in establishing effective blood management strategies. We aimed to examine the trends, risk factors, and complications of RBC transfusions in primary total knee arthroplasty (TKA) in China.

Materials and methods: The Hospital Quality Monitoring System was analyzed for patients undergoing primary TKA between 2013 and 2019. Trends in RBC transfusion rates, mean volume and cost were analyzed. Risk factors for transfusion were identified using multivariable logistic regression. After propensity score matching, the effects of transfusion on complications were examined using logistic regression, with the calculation of odds ratio (OR) and 95% confidence interval (CI).

Results: A total of 11,894 transfused patients and 162,349 non-transfused patients were included. Transfusion rates substantially declined from 20.0% in 2013 to 3.0% in 2019 (P for trend < 0.001), accompanied by a continuous decrease in mean volume (3.9 unit [U] to 2.9 U, P for trend < 0.001) and cost (1,021.8 Chinese Yuan [CNY] to 811.1 CNY, P for trend < 0.001) of transfusion. Risk factors for transfusion included older age (OR 1.37; 95%CI 1.24-1.51), female sex (OR 1.30; 95%CI 1.23-1.35), non-osteoarthritis indication (OR 1.57; 95%CI 1.47-1.69), preoperative anemia (OR 3.76; 95%CI 3.11-4.55), higher Charlson Comorbidity Index score (OR 1.16; 95%CI 0.99-1.36), and hospitals in central (OR 1.47; 95%CI 1.41-1.53) and west (OR 1.41; 95%CI 1.34-1.49) regions. On propensity-adjusted analyses, transfusion was associated with higher risk of 30-day readmission (OR 1.25; 95%CI 1.07-1.47) and deep vein thrombosis (OR 1.49; 95%CI 1.22-1.83), and increased costs (66,845.39 vs. 61,263.56 CNY, P < 0.001).

Conclusions: Rates, volumes, and costs of RBC transfusion in TKA have fallen substantially in China. However, several risk factors for transfusion should be recognized and appropriately managed, as RBC transfusion increased complication rates and socioeconomic burden.

Keywords: Blood transfusion; Complications; Risk factors; Total knee arthroplasty; Trends.

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Conflict of interest statement

Declarations. Ethical review: This study was authorized by the HQMS Committee Board and approved by the ethics committee of Xiangya Hospital (reference number: 2017121016). Informed consent: Not applicable. Statement: All of the authors have read and approved the contents of the manuscript. All authors fulfill the COPE (Committee on Publication Ethics) requirements for authorship. Each author believes that the manuscript represents honest work. Conflict of interest: The authors declare that they have no conflicts of interest.

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