Factors that influence blood loss requiring transfusion in total elbow arthroplasty: a retrospective study using ACS-NSQIP database

Abstract

Background

Blood loss requiring transfusion is common in orthopedic surgeries. This study aims to identify modifiable factors associated with higher blood loss requiring transfusion in total elbow arthroplasty (TEA).

Methods

Data from the American College of Surgeons National Surgical Quality Improvement Program’s database was analyzed. Patients who underwent primary TEA from 2006 to 2021 were categorized based on blood loss requiring transfusion. Preoperative variables and comorbidities were compared using a multivariate regression to determine odds ratios (ORs).

Results

Out of 654 patients, 30 (4.6%) experienced blood loss requiring transfusion following TEA. On multivariate logistic regression, the following variables were significant: low preoperative hematocrit (<36% in females, <41% in males) (OR 18.2, P < .01), inpatient location (OR 15.3, P < .01), elevated preoperative creatinine (>1.3 mg/dL) (OR 5.7, P < .01), active smoking (OR 2.2, P = .01), chronic obstructive pulmonary disease (OR 2.1, P = .02), and low white blood cell count (<4.5 × 10⁹/L) (OR 1.9, P = .03), and body mass index (OR 0.9, P < .01).

Conclusion

The overall rate of blood loss requiring transfusion in TEA was 4.6%. Identifying preoperative risk factors is crucial to minimize transfusion risk. Optimizing patient lab values may help reduce transfusion rates. Blood-saving techniques and antifibrinolytic agents like tranexamic acid should be considered for patients at increased risk of transfusion.