Risk factors for postoperative anemia and blood transfusion in primary anatomic and reverse total shoulder...

With the rise in outpatient shoulder arthroplasty, identifying patients at risk for postoperative blood transfusion is crucial. This study aims to identify risk factors for postoperative anemia and transfusion in primary shoulder arthroplasty.

A retrospective review of 3,253 primary arthroplasties (2,757 patients) who underwent reverse total shoulder arthroplasty (rTSA) and anatomic total shoulder arthroplasty from 2012 to 2022 was conducted. Revision arthroplasty, fracture-related arthroplasty, and hemiarthroplasty were excluded. Postoperative anemia was defined as hemoglobin (Hb) < 8 g/dL on postoperative day 0-1; postoperative transfusion was defined as receiving a transfusion prior to discharge. Binary logistic regression identified significant risk factors for postoperative anemia or blood transfusion.

Of 3,253 shoulder arthroplasties, 72.4% were rTSA and 27.6% were anatomic total shoulder arthroplasty. The overall rate of postoperative anemia was 0.01%, and the postoperative transfusion rate was 16.3%. Major risk factors for postoperative anemia included female sex (odds ratio [OR] 2.57; P = .010), American Society of Anesthesiologists score > 2 (OR 2.16; P = .047), and abnormal preoperative Hb (OR 2.40; P = .024). Major risk factors for postoperative transfusion included preoperative anticoagulant use (OR 10.34; P < .001) and lack of perioperative tranexamic acid (TXA) administration (OR 14.91; P < .001). Minor risk factors for postoperative transfusion included age >80 year old compared to age < 60 (OR 1.56; P = .022), female sex (OR 1.62; P < .001), blood disorder (OR 1.52; P = .004), genitourinary disorder (OR 1.73; P = .049), and rTSA (OR 1.52; P < .001).

Female sex, American Society of Anesthesiologists score > 2, and abnormal preoperative Hb are major risk factors associated with postoperative anemia, while preoperative anticoagulant use and lack of TXA are major risk factors for transfusion. TXA infusion displays a protective effect against transfusion but not postoperative anemia.