Blood Utilization After Primary Total Joint Arthroplasty in a Large Hospital Network

Antonia F. Chen, MD, MBA
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

Brian A. Klatt, MD
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

Mark H. Yazer, MD
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
The Institute for Transfusion Medicine, Pittsburgh, PA

Jonathan H. Waters, MD
Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA


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 4.863.8%, THA 4.386.8%). 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.

This Online First Article was published June 2013.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

^ Back to Top
Request an Appointment