A Retrospective Single-Center Cohort Study on Heme Transfusions in Orthopedic Surgeries

Area of Science:

• Orthopedics
• Transfusion Medicine
• Patient Safety

Background:

• Blood transfusions are vital in orthopedic surgery but carry risks.
• Major orthopedic procedures like joint arthroplasties and spinal surgeries often involve significant blood loss.
• Current transfusion practices may lack standardization, potentially impacting patient outcomes.

Purpose of the Study:

• To evaluate blood transfusion rates and practices in major orthopedic surgeries.
• To identify predictors of transfusion requirements in this patient population.
• To assess the impact of transfusions on clinical outcomes and compare institutional triggers to guidelines.

Main Methods:

• Retrospective cohort study of 395 major orthopedic surgeries at RL Jalappa Hospital, India (Feb 2023 - Jan 2024).
• Data collected on transfusion rates, patient demographics, surgical factors, and clinical outcomes.
• Multivariate analysis used to identify predictors of transfusion and logistic regression for outcome comparisons.

Main Results:

• Overall transfusion rate was 10.3%, varying by procedure type (e.g., 22.4% in spinal surgeries).
• Predictors included advanced age, preoperative anemia, prolonged surgery, and high blood loss.
• Transfused patients had longer hospital stays (7.2 vs 4.5 days), higher complication rates (24% vs 8%), and increased readmissions (8% vs 3%).
• 42% of transfusions in stable patients occurred at hemoglobin >8 g/dL, deviating from guidelines.

Conclusions:

• Significant variation exists in orthopedic surgical transfusion practices.
• Transfusions are associated with poorer patient outcomes, highlighting the need for optimization.
• Developing standardized, evidence-based transfusion protocols and blood management programs is essential.