Bleeding in primary shoulder arthroplasty.

Area of Science:

• Orthopedic Surgery
• Hemorrhage Management
• Biomedical Engineering

Background:

• Shoulder arthroplasty (SA) encompasses reverse, anatomical, and stemless designs.
• Understanding blood loss and transfusion rates is crucial for patient safety and optimizing surgical outcomes.
• This study analyzes total blood loss (TBL), blood transfusion (BT) rates, and blood units (BU) transfused across primary SA types.

Purpose of the Study:

• To compare TBL, BT rates, and BU between reverse, anatomical, and stemless primary SA.
• To identify risk factors associated with TBL, BU, and BT rates in shoulder arthroplasty patients.

Main Methods:

• Retrospective analysis of 278 patients undergoing primary SA between 2004 and 2016.
• Data collected included demographics, comorbidities, hemoglobin, hematocrit, BT rate, and BU.
• Statistical analyses (linear regression, log-linear poisson, logistic regression) were used to compare outcomes and identify risk factors.

Main Results:

• Mean TBL was similar for reverse (392.7 ml) and anatomical (394.6 ml) SA, but lower for stemless (298.3 ml).
• BT rates were 14.4% (0.32 BU) for reverse and 8.77% (0.23 BU) for anatomical SA.
• No stemless SA patients received BT. Operation time, BMI, and male sex impacted TBL; low BMI, cemented arthroplasty, coronary heart disease, high ASA score, and vitamin K antagonist use impacted BT/BU.

Conclusions:

• No significant difference in TBL between reverse and anatomical SA, though BT rates varied slightly.
• Stemless SA demonstrated a notable absence of blood transfusions.
• Distinct risk factors influence TBL and BT rates, suggesting tailored management strategies may be beneficial.