Perioperative Transfusion in Total Hip Arthroplasty: Predictive Factors and Outcomes

Total hip arthroplasty is a common orthopedic procedure with significant hemorrhagic risks, often necessitating postoperative transfusions to treat anemia. Transfusions carry considerable costs and complications, including infection, necessitating judicious use. Identifying factors influencing transfusion rates in hip arthroplasty can improve perioperative management.

Records of 3,865 patients who underwent primary total hip arthroplasty at a university center from 2002 to 2020 were retrospectively reviewed. Factors analyzed included age, sex, BMI, ASA physical status classification, surgical indication, operation duration, surgical approach, additional procedures, hospital stay duration, intraoperative complications, postoperative infections, anticoagulation, tranexamic acid use, anti- inflammatory use, and pre- and postoperative hemoglobin levels. Data were analyzed using descriptive, univariate, and multivariate analyses.

The overall transfusion rate was 9.4%. Transfusion rates decreased from 28.5% (2002-2003) to 11.3% (2004-2012) and 4.3% (2013-2020). Multiple logistic regression showed that female sex, surgical indication, surgical approach, longer operative time, higher ASA scores, and greater postoperative hemoglobin drop significantly increased transfusion risk. Conversely, tranexamic acid and anti-inflammatory use, and higher body weight significantly decreased transfusion risk. Infection rates were higher among transfused patients (3%) compared to non-transfused patients (0.83%).

Reducing transfusion use is essential due to the scarcity of blood, associated costs, and complications, necessitating a standardized transfusion policy and perioperative care protocols. Optimizing preoperative hemoglobin, using controlled hypotension anesthesia, minimally invasive surgical approaches, consistent surgical techniques, perioperative tranexamic acid, and postoperative anti-inflammatory use are crucial to reducing.