Patient characteristics and adverse effects of allogeneic blood transfusion following lower extremity joint replacement in rheumatoid arthritis: a nationwide inpatient sample database study

Abstract

Objectives: Allogeneic blood transfusion is a common therapeutic intervention for patients with rheumatoid arthritis (RA) undergoing lower extremity joint replacement (LEJR). Despite the potential for adverse outcomes associated with blood transfusion, the risks related to this procedure in RA patients remain underexplored, particularly within the framework of a large-scale national dataset.

Methods: This study analyzed data from the National Inpatient Sample (NIS) database from 2010 to 2019, identifying 66,674 patients diagnosed with RA who underwent LEJR. These cases were subsequently divided into two groups based on whether they received blood transfusion. Univariate and multivariate logistic regression analyses were conducted on patient demographics, the prevalence of comorbidities, hospital-level characteristics, total financial charges, insurance coverage, and in-hospital mortality rates.

Results: The cumulative blood transfusion rate among RA patients undergoing LEJR was 10.9%, showing a declining trend over the study period (from 23.79% in 2010 to 3.67% in 2019). Several factors were associated with an increased likelihood of receiving blood transfusion, including advanced age (≥ 65 years), female sex, deficiency anemia, chronic blood loss anemia, weight loss, coagulopathy, fluid and electrolyte imbalances, neurological disorders, pulmonary circulatory disturbances, congestive heart failure, chronic kidney disease, and uncomplicated diabetes. Moreover, patients who received blood transfusion demonstrated a higher risk of specific complications, including wound infection, acute myocardial infarction, pneumonia, acute kidney injury, urinary tract infection, postoperative delirium, deep vein thrombosis, lower limb nerve injury, sepsis, and respiratory failure.

Conclusion: Thorough preoperative assessment is essential for identifying RA patients who were more likely to receive blood transfusion and be subjected to adverse outcomes. Proactive interventions during the perioperative period, coupled with the implementation of a comprehensive blood management strategy, can optimize blood transfusion in RA patients after LEJR.

Keywords: Lower extremity joint replacement; Rheumatoid arthritis; Risk factors; Transfusion.

Fig. 1

Annual incidence of blood transfusion in patients with RA Undergoing LEJR

Fig. 2

Patient demographics between the two groups. (A) Age distribution analysis of blood transfusion patients. (B) Age distribution analysis of patients without blood transfusion. (C) Gender distribution analysis of transfusion patients. (D) Gender distribution analysis of patients without blood transfusion. (E) Distribution of the number of comorbidities among patients in the transfusion group. (F) Distribution of the number of comorbidities among patients without blood transfusion

Fig. 3

Incidence of postoperative complications related to blood transfusion. A. Analysis of hospital regional distribution of blood transfusion patients. B. Analysis of hospital regional distribution of patients without blood transfusion. C. Analysis of Insurance Types for blood transfusion Patients. D. Analysis of Insurance Types for Patients without blood transfusion. E. Analysis of the number of hospital beds for blood transfusion patients. F. Analysis of the number of hospital beds for patients without blood transfusion

Fig. 4

Relationship between blood transfusion and preoperative comorbidities

Fig. 5

Incidence of postoperative complications related to blood transfusion

Fig. 6

Relationship between blood transfusion and postoperative complications