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Analysis of Transfusion Predictors in Shoulder Arthroplasty
Peter J. Millett, MD, MSc1; Mason Porramatikul, MD2; Neal Chen, MD3; David Zurakowski, PhD4; Jon J.P. Warner, MD5
1 Steadman Hawkins Clinic, 181 West Meadow Drive, Vail, CO 81657. E-mail address: drmillett@steadman-hawkins.com
2 Department of Orthopedic Surgery, Bangkok Metropolitan Administration, Medical College and Vajira Hospital, 681 Samsen Road, Dusit District, Bangkok 10300, Thailand
3 Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114
4 Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
5 Harvard Shoulder Service, 55 Fruit Street, Yawkey Center for Outpatient Care, Suite 3200, 3G, Room 3-044, Boston, MA 02114
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Harvard Shoulder Service, Brigham and Women's Hospital, and Massachusetts General Hospital, Boston, Massachusetts

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Jun 01;88(6):1223-1230. doi: 10.2106/JBJS.E.00706
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Abstract

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.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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