Complications associated with preoperative anemia and risk factors for blood transfusion after shoulder arthroplasty: a systematic review

Abstract

Background

Patients with preoperative anemia (PA) demonstrated higher complications rates following several orthopedic procedures. This systematic review aims to assess outcomes in patients with PA undergoing shoulder arthroplasty (SA) and to identify risk factors contributing to increased post-transfusion rates following SA.

Methods

This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines outlined by Cochrane Collaboration. A search of PubMed, the Medline Library, and EMBASE from inception until September 2023 was conducted to obtain studies reporting on complications after SA in patients with PA. Study demographics and information on outcomes including outcomes and complication rates were collected. The methodological quality of included primary studies was appraised using the methodological index for nonrandomized studies scoring system.

Results

Between 2006 and 2023, 17 articles meeting inclusion criteria were published and analyzed in this systematic review, encompassing a total of 201,442 patients. Four studies with a total of 145,787 patients (63.7% female) with mean age of 72.6 years investigated PA, and 26,130 patients had PA. Thirteen studies investigated blood transfusion risk in 55,655 patients (56.9% female) with a mean age of 64.1 years. Patients with PA demonstrated a 24.4% complication rate, compared to 8.8% in those without such a diagnosis. Stratification by PA severity revealed a 34.9% complication rate in patients with moderate to severe PA. Notably, lower preoperative hemoglobin (Hb < 13.5 g/L) and revision SA were correlated with a higher risk of postoperative transfusion.

Conclusion

Patients with PA had elevated rates of complications, readmissions, and reoperations after SA. Furthermore, lower preoperative Hb levels and revision SA were associated with an increased risk of postoperative transfusion. This systematic review indicated that PA may have adverse effects on outcomes after SA and suggested that preoperative optimization of patients with PA may reduce complication rates after SA. Moreover, this data suggests that preoperative optimization of patients with PA may improve outcomes after SA.