Transfusion Rate Decline: “Remarkable”

Have blood transfusion rates following Primary and Revision Total Joint Arthroplasty truly declined? If so, what specific patient factors are associated with transfusions?

New work from the University of Iowa addresses these issues. The study, “Who Is Still Receiving Blood Transfusions After Primary and Revision Total Joint Arthroplasty?” appears in the August 24, 2021, edition of The Journal of Arthroplasty.

Co-author John Callaghan, M.D., the Lawrence and Marilyn Dorr Chair Emeritus and Professor Emeritus of the Department of Orthopaedics and Biomedical Engineering at the University of Iowa, explained to OTW, “In recent years, there has been increased emphasis on preoperative patient optimization and interventions to reduce blood transfusions following total joint arthroplasty at many centers. These include preoperative correction of anemia, use of tranexamic acid, fewer surgeons using suction drains, expansion of spinal anesthesia, and implementation of restrictive transfusion protocols.”

“Given these improvements in care over the last decade, it seemed like the right time to assess what progress we’ve made, on a national level, towards reducing blood transfusions following primary and revision arthroplasty.”

Using the American College of Surgeons National Surgical Quality Improvement Program database, the researchers identified patients undergoing either primary or revision total joint arthroplasty between 2011 and 2019. The team excluded any individual who had bilateral procedures and arthroplasty for fracture, infection, or tumor; patient factor association with blood transfusions was determined using data from 2018 and 2019.

“Remarkable”

“The most important results were that transfusions have become a rarity in contemporary, primary total joint arthroplasty. In 2019, only 2.5% and 0.7% of patients required a blood transfusion following primary total hip and knee arthroplasty, respectively.”

“Blood transfusions have been also become less common following revision procedures in recent years. In 2019, transfusion rates were 12.0% for hip and 2.6% for knee revision arthroplasty. The current rates are even more remarkable when considering the rates were 21.4% for primary hips, 17.6% for primary knees, 33.5% for revision hips, and 17.6% for revision knees in 2011.”

“Lower preoperative hematocrit was found to be strongly correlated with higher odds for a needing a blood transfusion in both primary and revision procedures.”

Not an “Always Event”…but not a “Never Event”

“Another important finding from this study is that transfusions have not reached the status of a ‘never event’—some patients, due to a variety of factors, will still need a transfusion. Despite the improvements in transfusion rates over the years, there is continued room for improvement, particularly in our patients undergoing aseptic or septic revisions, simultaneous bilateral total joint arthroplasty, or with preoperative anemia.”