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HSS Journal ®

, Volume 9, Issue 2, pp 123–128

First Online: 21 June 2013Received: 01 October 2012Accepted: 04 January 2013


BackgroundSince a study in orthopedic hip fracture patients demonstrated that a liberal hemoglobin Hb threshold does not improve patient morbidity and mortality relative to a restrictive Hb threshold, the standard of care in total joint arthroplasty TJA should be examined to understand the variability of red blood cell RBC transfusion following TJA.

Questions-purposesThe study aimed to answer the following questions: 1 What is the blood utilization rate after primary TJA for individual surgeons within a large hospital network? 2 What is the comparison of hospital charges, length of stay LOS, and discharge locations among TJA patients who were and were not transfused?

MethodsA retrospective study was conducted on 3,750 primary total knee arthroplasties TKAs and 2,070 primary total hip arthroplasties THAs, and data was retrospectively collected over a 15-month period on the number of RBCs transfused per patient, along with demographic and cost details. The number of patients who received at least 1 RBC unit and the number of RBCs transfused per patient was calculated and stratified by surgeon.

ResultsIn the postoperative period, 19.3% TKA patients and 38.5% THA patients received a RBC transfusion. Transfusion rates following TJA varied widely between surgeons TKA 4.8–63.8%, THA 4.3–86.8%. Transfused TKA patients received an average of 1.65 ± 0.03 RBCs, and THA patients received an average of 1.97 ± 0.14 RBCs. LOS and hospital charges for blood transfusion patients were higher than nontransfused patients.

ConclusionBlood utilization after primary TJA varies greatly among surgeons, suggesting that resources may be misallocated. These findings highlight the need to standardize RBC transfusion practice following TJA.

Keywordstotal joint arthroplasty blood utilization transfusion rate blood management red blood cell RBC transfusion intervention This work was performed at the University of Pittsburgh Medical Center.

Level of evidence: Therapeutic study, level III retrospective study.

Electronic supplementary materialThe online version of this article doi:10.1007-s11420-013-9327-y contains supplementary material, which is available to authorized users.

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Autor: Antonia F. Chen - Brian A. Klatt - Mark H. Yazer - Jonathan H. Waters


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