Risk factors associated with blood transfusion after shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Research
• Surgical Outcomes

Background:

• Closed-suction drainage is common in hip and knee replacements, but its impact on shoulder arthroplasty outcomes, especially transfusion needs, is less understood.
• Research on drainage after shoulder arthroplasty is limited, necessitating further investigation into its relationship with patient outcomes and blood loss.

Purpose of the Study:

• To investigate the association between closed-suction drainage and transfusion requirements following primary total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA).
• To identify independent risk factors for blood transfusion in patients undergoing TSA and RSA.

Main Methods:

• A retrospective review of primary TSA and RSA procedures at a single institution over five years.
• Data collection included patient demographics, estimated blood loss (EBL), drain output, drain duration, hemoglobin (Hgb) levels, transfusion status, and complications.
• Multivariable regression analysis was used to determine independent risk factors for transfusion.

Main Results:

• Reverse total shoulder arthroplasty (RSA) patients were older, had lower preoperative and postoperative Hgb, longer hospital stays, longer drain durations, and higher transfusion rates compared to total shoulder arthroplasty (TSA) patients.
• While RSA had increased wound drainage, it was not a significant risk factor for transfusion.
• Low preoperative Hgb levels were identified as independent risk factors for transfusion in both TSA and RSA, with higher EBL also being a risk factor in TSA.

Conclusions:

• Low preoperative hemoglobin level is a significant independent predictor of transfusion necessity after both TSA and RSA.
• Increased wound drainage following shoulder arthroplasty does not appear to be a risk factor for requiring blood transfusion.
• The observed increase in wound drainage in RSA is of minimal clinical significance regarding transfusion risk.