Recent Trends in Blood Utilization After Revision Hip and Knee Arthroplasty

Blood transfusion guidelines in elective surgery have been implemented over the last decade to minimize risk and cost related to transfusion without sacrificing patient outcomes. Blood utilization in primary total hip (THA) and total knee arthroplasty (TKA) has been extensively studied but there is a paucity of studies evaluating utilization in revision THA and TKA. The purpose of this study is to evaluate current trends in transfusion following revision THA and TKA.

The Humana dataset was reviewed for transfusion trends from 2007 to 2015 for patients undergoing revision THA and TKA. Subgroup analysis was performed to evaluate the impact of age, gender, geographic location, and obesity.

In total, 9176 and 12,493 revision THA and TKA patients were analyzed with transfusion rates of 19.2% and 11.9%, respectively. Allogeneic packed red blood cells were most commonly transfused (90% and 92%, respectively). Transfusion rates decreased significantly from 24.7% to 10.3% and 15.9% to 4.5%, respectively, over the years 2007-2015. Women had higher transfusion rates (odds ratio [OR] THA:TKA 1.24:1.23), while obesity was associated with lower transfusion rates after revision THA (OR 0.88). Transfusion rates were higher in 2-component revisions compared to primary (OR THA:TKA 1.24:1.24), while 1-component revisions had lower transfusion rates than primary procedures (OR THA:TKA 0.79:0.25).

Transfusion rates after revision THA and TKA have fallen substantially since 2007. In 2016, only 10% and 4% of revision THA and TKA, respectively, required transfusion. The study should provide benchmark data for surgeons to use as comparison to the blood utilization following revision joint replacement at their institutions.