Risk factors associated with blood transfusion after shoulder arthroplasty

Closed-suction drainage has been studied extensively in hip and knee arthroplasty literature. However, little is known about outcomes in patients treated with drainage after shoulder arthroplasty, particularly relative to transfusion requirements.

All primary total and reverse total shoulder arthroplasties (TSAs and RSAs) performed at a single institution during a 5-year period were retrospectively reviewed. Data collected included patient demographic information, estimated blood loss (EBL), drain output, length of drain use, changes in hemoglobin (Hgb) level postoperatively, transfusions, and complications. A multivariable regression analysis was performed to identify independent risk factors for transfusion.

There were no differences in surgery duration, EBL, or complications between TSA and RSA patients (P > .05). Patients undergoing RSA were older (74.0 vs. 68.4 years; P < .001) and had lower preoperative and postoperative Hgb levels (P < .001) compared with TSA patients. Reverse arthroplasty was also associated with longer hospital stays (2.8 vs. 2.2 days; P < .001), longer drain durations (1.6 vs. 1.2 days; P < .001), increased total wound drainage (209 vs. 168 m; P = .006), and higher transfusion rates (11.7% vs. 3.1%; P = .002). Independent risk factors for transfusion included low preoperative Hgb levels in both TSA (P = .024) and RSA (P = .002) and higher EBL in TSA (P = .031).

Low preoperative Hgb level is an independent risk factor for requiring blood transfusion after TSA and RSA. Increased wound drainage was not a risk factor for transfusion, and the 40-mL increase in wound drainage found in RSA is of questionable clinical significance.