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A multivariable model for perioperative transfusion risk in elective primary THA
Nikolai Ramadanov1,2, Maximilian Voss3,4, Maximilian Heinz3,4
1Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg, Brandenburg/Havel, Germany. nikolai.ramadanov@gmail.com.
BMC Musculoskeletal Disorders
|June 9, 2026
Summary
Predicting blood transfusions after hip replacement surgery is possible using patient data. This helps in managing blood use and improving patient care before and after total hip arthroplasty (THA).
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Perioperative blood transfusion is a significant concern in elective total hip arthroplasty (THA), linked to adverse outcomes.
- There's a need for reliable tools to stratify transfusion risk using routine clinical data for personalized blood management.
Purpose of the Study:
- To develop and validate a predictive model for perioperative allogeneic red blood cell transfusion in elective primary THA.
- To identify independent predictors of transfusion using routinely available clinical variables.
Main Methods:
- Retrospective cohort study of 648 patients undergoing elective primary THA (2016-2023).
- Data extracted from a registry included demographics, comorbidities (ASA), lab values, operative characteristics, and blood loss.
- Univariable and multivariable logistic regression, ROC analysis, and calibration testing were used.
Main Results:
- 16.0% of patients required perioperative transfusion.
- Predictors of transfusion included lower preoperative hemoglobin, longer operative time, greater intraoperative blood loss, and lower body mass index.
- Male sex was inversely associated with transfusion; higher comorbidity burden (ASA ≥ III) showed a borderline association.
Conclusions:
- A predictive model using routine clinical variables demonstrated excellent discrimination (AUC 0.878) for perioperative transfusion in THA.
- The model supports perioperative risk assessment and individualized blood management.
- External validation is needed before routine clinical application; applicability for patient counseling is limited.
