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Blood Transfusion Trends in Primary and Revision Total Joint Arthroplasty: Recent Declines Are Not Shared Equally

Kimball, Chloe C. BA; Nichols, Christine I. MA, MBA; Vose, Joshua G. MD, MBA

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: October 15, 2019 - Volume 27 - Issue 20 - p e920-e927
doi: 10.5435/JAAOS-D-18-00205
Research Article
SDC

Introduction: This study examined whether recent nationwide declines in the incidence of transfusion following total joint arthroplasty were equal across inpatient facilities.

Methods: This analysis used the Premier database (2010 to 2015). Cohorts of primary total hip or knee arthroplasty (THA or TKA) and revision THA or TKA were defined.

Results: Among 1,013,024 patients who met selection criteria, the overall incidence of transfusion declined from 2010 through 2015 (primary THA: 22.1% to 7.1%; primary TKA: 18.1% to 3.2%; revision THA: 30.6% to 18.5%; and revision TKA: 19.8% to 9.8%; all P < 0.001). However, patients older than 65 years were associated with lower odds of transfusion relative to those younger than 65 years (P < 0.05 for three of four cohorts); smaller hospitals were associated with higher odds versus large hospitals (P < 0.05 all cohorts), and academic hospitals were associated with higher odds of transfusion versus community facilities (P < 0.05 for three of four cohorts).

Discussion: During this study period, a meaningful proportion of total joint arthroplasty procedures were performed at facilities with the most room to improve. Decreases in transfusion rates were dependent on specific hospital characteristics; these results may help direct targeted improvement initiatives.

Level of Evidence: Level III

From Medtronic Transformative Solutions, Medical Affairs, Portsmouth, NH.

Correspondence to Dr. Vose: vose@mit.edu

Ms. Kimball or an immediate family member is an employee of and has stock or stock options held in Medtronic. Ms. Nichols or an immediate family member is an employee of and has stock or stock options held in Medtronic. Dr. Vose or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Medtronic; serves as a paid consultant to Perimeter Medical and Stanley Healthcare; serves as an unpaid consultant to EnClear Therapeutics; and has stock or stock options held in Veristride.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jaaos.org).

Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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