Risk factors for postoperative blood transfusion after shoulder arthroplasty.

Area of Science:

• Orthopedic Surgery
• Transfusion Medicine
• Patient Safety

Background:

• Allogeneic red blood cell (RBC) transfusion is a common complication in orthopedic surgery.
• Identifying risk factors for transfusion after shoulder arthroplasty (SA) is crucial for optimizing patient outcomes and managing blood resources.
• Previous studies have not comprehensively evaluated the impact of surgical indication on transfusion rates in SA.

Purpose of the Study:

• To determine the influence of surgical indication, patient factors, and perioperative characteristics on the likelihood of requiring RBC transfusion following SA.
• To identify specific risk factors associated with postoperative allogeneic RBC transfusion in SA.

Main Methods:

• Retrospective analysis of 274 shoulder arthroplasties performed over a 6-year period at a single institution.
• Surgical indications included osteoarthritis, rotator cuff arthropathy, fracture, revision, and periprosthetic joint infection (PJI).
• Multivariate logistic regression was used to assess patient-based and surgical risk factors for postoperative allogeneic RBC transfusion.

Main Results:

• Transfusion rates were significantly higher for PJI (23%) and fracture (18%) indications compared to osteoarthritis or rotator cuff arthropathy (2%).
• Independent risk factors for transfusion included lower preoperative hemoglobin levels (p < 0.001), PJI indication (p = 0.008), and fracture indication (p = 0.02).
• Mean preoperative hemoglobin was lower in PJI and fracture cases compared to other indications.

Conclusions:

• Low preoperative hemoglobin and specific surgical indications, namely PJI and fracture, are significant risk factors for allogeneic RBC transfusion after shoulder arthroplasty.
• These findings can aid in preoperative risk stratification and patient counseling for shoulder arthroplasty.
• Further research could explore targeted transfusion strategies for high-risk SA cases.