Analysis of complication rates following perioperative transfusion in shoulder arthroplasty

• Published in: Journal of shoulder and elbow surgery 2017-07, Vol.26 (7), p.1203-1209
• Main Authors: Grier, A. Jordan, MD, Bala, Abiram, MD, Penrose, Colin T., MD, Seyler, Thorsten M., MD, PhD, Bolognesi, Michael P., MD, Garrigues, Grant E., MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anemia - epidemiology; arthroplasty; Arthroplasty, Replacement, Shoulder; Blood Transfusion; Case-Control Studies; Comorbidity; complications; Databases, Factual; Female; Humans; Incidence; Male; North Carolina - epidemiology; Odds Ratio; Orthopedics; Perioperative Care; Postoperative Complications - epidemiology; replacement; Retrospective Studies; reverse; shoulder; Total; transfusion
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2016.11.039

Background Postoperative anemia requiring a blood transfusion is not uncommon following anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). However, the potential complications in patients undergoing transfusion after shoulder arthroplasty remain unclear. The goal of this study was to examine the postoperative outcomes of patients receiving blood transfusions following TSA and RTSA. Methods Using the Medicare Standard Analytic Files database, we identified all patients undergoing TSA or RTSA between 2005 and 2010. Using International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology codes, we identified the procedure, transfusion status, comorbidities, and postoperative complications of interest. Odds ratios and 95% confidence intervals were calculated. Results We identified 7,794 patients who received a perioperative blood transfusion following TSA or RTSA, as well as 34,293 age- and gender-matched controls, during the study period. Patients who received a perioperative transfusion had statistically significantly higher rates of myocardial infarction, pneumonia, systemic inflammatory response syndrome or sepsis, venous thromboembolic events, and cerebrovascular accidents at all time points in question. Patients who received a blood transfusion also showed an increased incidence of surgical complications, including periprosthetic infection and mechanical complications, up to 2 years postoperatively. Conclusion To our knowledge, this represents the largest study to examine the relationship between the need for perioperative blood transfusion and postoperative medical and surgical outcomes following TSA and RTSA. The results observed in this study highlight the importance of preoperative counseling and medical optimization prior to shoulder arthroplasty, particularly in patients with preoperative anemia or multiple medical comorbidities.