Background: We are not aware of any previous study that has examined
predictive factors for blood transfusion after shoulder arthroplasty. We
analyzed the association between clinical factors and the need for
postoperative blood transfusion and documented the use and waste of predonated
blood in a group of patients managed with shoulder arthroplasty.
Methods: A retrospective study of 119 patients who underwent 124
shoulder arthroplasties (including eighty-seven primary uncomplicated total
shoulder arthroplasties, twenty-seven revision or complicated primary total
shoulder arthroplasties, and ten hemiarthroplasties) from 2001 to 2004 was
performed. Logistic regression analysis was conducted to determine which
clinical variables were predictive of transfusion.
Results: A postoperative transfusion was received after thirty-one
arthroplasties (25%). The strongest predictor of blood transfusion after
shoulder arthroplasty was the preoperative hemoglobin level (likelihood ratio
test = 37.8, p < 0.0001). Patients with a preoperative hemoglobin level of
between 110 and 130 g/L had a five times greater estimated risk of transfusion
than those with a level of >130 g/L (p < 0.001). Gender, body mass
index, preoperative diagnosis, comorbid conditions, use of anticoagulants or
aspirin, autologous predonation status, type of anesthesia, operative time,
and decrease in hemoglobin or hematocrit were not predictors of blood
transfusion. One hundred and two (78%) of the 131 predonated autologous units
were discarded. Patients with a preoperative hemoglobin level of >130 g/L
had the highest percentage of wasted units (90%; fifty-five of sixty-one).
Preoperative autologous blood donation did not eliminate the risk of
allogeneic blood transfusion in autologous donors.
Conclusions: The preoperative hemoglobin level is the strongest
predictor of blood transfusion after shoulder surgery, and individuals with a
preoperative hemoglobin level of <110 g/L have the highest risk of
transfusion. On the basis of these findings, we do not recommend autologous
predonation for individuals with a preoperative hemoglobin level of >130
g/L, to avoid unnecessary expense and waste.
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.