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Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 43-50

Perioperative blood transfusions and complication rates in total elbow arthroplasty

1 Department of Surgery, University of Alabama, Birmingham, AL, USA
2 Department of Orthopaedic Surgery, University of California San Diego, San Diego, USA
3 Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Redwood City, CA, USA
4 Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA

Correspondence Address:
Dr. Cary S Politzer
Department of Orthopaedic Surgery, University of California San Diego, 200 W Arbor Dr, San Diego, California 92003
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/DORJ.DORJ_4_19

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Aim: Complication rates for total elbow arthroplasty (TEA) have not been well studied. The aim of this study was to analyze its utilization rate, the use of perioperative packed red blood cell transfusions, overall rates of surgical complications, and any association of perioperative transfusions with short-term postoperative medical and long-term surgical complications. Materials and Methods: We queried a large Medicare Standard Analytic Files database from 2005 to 2014 to identify index surgery, perioperative blood transfusions, and postoperative complications. Incidence, odds ratios (ORs), 95% confidence intervals, and P values were calculated for 30-day, 90-day, and 2-year postoperative complications. Results: We identified a total of 7480 primary TEA procedures with a minimum of 2-year follow-up. 577 of these patients received perioperative blood transfusion, whereas 2058 age- and gender-matched controls did not. The transfusion cohort had statistically significantly higher rates of 30-day medical complications such as anemia (OR, 7.54), acute kidney injury (OR, 5.55), sepsis (OR, 4.97), myocardial infarction (OR, 3.36), respiratory failure (OR, 3.17), heart failure (OR, 2.56), pneumonia (OR, 2.46), and urinary tract infection (OR, 2.19). They also had higher rates of infection-related surgical complications within 90 days such as periprosthetic infection (OR, 3.36) and cellulitis/seroma (OR, 2.12) and more blood transfusions (OR, 2.59), which remained significantly elevated at 2 years after surgery. Conclusions: Patients requiring perioperative transfusions after surgery have higher rates of complications. Clinical Significance: Surgeons should preoperatively mitigate transfusion risk and preemptively counsel patients during admission and discharge. Further evidence is needed to determine whether perioperative transfusion is a marker of overall poor health or whether transfusion has an immunomodulatory effect that increases complication risk.

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