Effect of Preoperative transfusion on Postoperative Complications after Total Hip Arthroplasty

Primary total hip arthroplasty (THA) is among the most common surgical procedures and clinically known to cause significant intraoperative blood loss requiring peri- and post-operative transfusion. Multiple studies have shown post-operative transfusions are associated with greater complications and subsequent prolonged recovery, however limited studies exist in determining whether similar post-operative risks are observed in THA patients receiving pre-operative transfusions. Based on studies conducted on post-operative transfusions, it was hypothesized that pre-operative transfusions would be associated with an increased risk for post-operative complications. In total, 74,814 patients from the National Surgical Quality Improvement Project Database between 2005-2014 were studied with specific readmission/reoperation data beginning in 2011. Complications were divided post-operative complications (directly related to the procedure), and non-operative complications (not associated with procedure), and co-morbidities were controlled during multi-variate analysis. Pre-operative transfusion in THA patients was found to be an independent predictor of organ space infection (OR: 5.41), pneumonia (OR: 2.66), failure to wean (OR: 13.84), urinary tract infection (OR: 3.42), cardiac arrest (OR: 5.83), transfusion post-operatively (OR: 5.94), and non-home discharge (OR: 3.18). Overall, patients receiving blood products prior to a primary THA are at increased risk of operative and non-operative complications including increased infection risk, prolonged hospital stay, discharge to a non-home facility, and potential cardiac arrest leading to resuscitation. Future medical decision making regarding pre-operative anemia management in primary THA cases should entail a careful risk-benefit analysis of transfusion and potentially include higher thresholds to transfuse preoperatively as well as, close monitoring in order to prevent complications