Analysis of Predictors and Outcomes of Allogeneic Blood Transfusion After Shoulder Arthroplasty
In shoulder arthroplasty, patients often receive postoperative blood transfusions. Studies of predictors of allogeneic blood transfusion (ABT) in these patients have been limited by sample size.
We conducted a study to identify predictors of ABT in patients undergoing shoulder arthroplasty and to evaluate the effect of ABT on postoperative outcomes, including inpatient mortality, adverse events, prolonged hospital stay, and nonroutine discharge. Using the Nationwide Inpatient Sample, we stratified an estimated 422,371 patients who presented for shoulder arthroplasty between January 1, 2002, and December 31, 2011, into total shoulder arthroplasty (59.3%) and hemiarthroplasty (40.7%) cohorts, and then subdivided these cohorts into patients who received blood transfusions and those who did not.
Patients who received ABTs were older, female, and nonwhite and had Medicare or Medicaid insurance. Many had a primary diagnosis of proximal humerus fracture. Those who received ABT were more likely to experience adverse events or a prolonged hospital stay and were more often discharged to a nursing home or an extended-care facility. The 5 most significant predictors of ABT in a population of 422,371 patients who underwent shoulder arthroplasty were fracture, fracture nonunion, deficiency anemia, coagulopathy, and avascular necrosis.
Given these findings, it is important to identify at-risk patients before surgery in order to provide education and minimize risk.
Conclusion
Our results confirmed previous findings and identified new predictors of ABT in shoulder arthroplasty in a large cohort. We examined demographics and perioperative complications while identifying predictors of ABT use. Patients who received ABT were older, female, and nonwhite and were covered by Medicare or Medicaid insurance, and many had a primary diagnosis of proximal humerus fracture. The ABT cohort had numerous medical comorbidities, including deficiency anemia and coagulopathy. Identifying this patient population is a prerequisite to educating patients while minimizing unnecessary risks and costs.
Using NIS data on a population of 422,371 patients who underwent shoulder arthroplasty, we identified the 5 likeliest predictors of ABT: fracture, fracture nonunion, deficiency anemia, coagulopathy, and avascular necrosis. Of the identified variables associated with ABT, deficiency anemia may be the most amenable to treatment; therefore, there may be benefit in delaying elective shoulder arthroplasty in this cohort. Given these findings, it is important to identify at-risk patients before surgery, with the intent to provide education and minimize risk.
