Thursday, February 11, 2016

Will I need a blood transfusion with my shoulder joint replacement arthroplasty?

Risk factors for blood transfusion after shoulder arthroplasty

The authors identified 1174 shoulder arthroplasties performed on 1081 patients. Of these, 53 (4.5%) required transfusion post-operatively. Patients typically underwent transfusion if they had a level of haemoglobin of < 7.5 g/dl if asymptomatic, < 9.0 g/dl if they had a significant cardiac history or symptoms of dizziness or light headedness.

Predictors of blood transfusion were a lower pre-operative haematocrit (p < 0.001) and shoulder arthroplasty undertaken for post-traumatic arthritis (p < 0.001). ROC analysis identified pre-operative haematocrit of 39.6% as a 90% sensitivity cut-off for transfusion. In total 48 of the 436 (11%) shoulder arthroplasties with a pre-operative haematocrit < 39.6% needed transfusion compared with five of the 738 (0.70%) shoulder arthroplasties with a haematocrit above this level.

Comment: While we agree with these authors' threshold for transfusion, in our practice it is very rare for patients to need a transfusion after shoulder arthroplasty, even though many have preoperative hematocrits in the 32-39% range. Our preoperative blood loss is typically in the 250 cc range.

There has been concern about the increased risk of infection with blood transfusions and shown in this link. Information about the trends in transfusion after shoulder arthroplasty is given in this link.

New strategies for minimizing preoperative blood loss are described in this link.