Risk of blood transfusion following total hip arthroplasty: A national database study from 367,894 patients

Purpose: A growing elderly population in the United States coupled with improvement in surgical techniques have resulted in more elderly individuals undergoing total hip arthroplasty (THA). As such, risk factors associated with increased risk of blood transfusion following THA, which has been linked to various detrimental outcomes, must be better understood. This study aims to identify co-morbidities associated with blood transfusion following THA. Methods: Using the Nationwide Inpatient Sample (NIS) database, we selected patients that received a THA from 2016 to 2019 using ICD-10CMP codes. Patients were classified into a “blood transfusion” or “no transfusion” groups and data pertaining to demographics, co-morbidities, and events during hospital stays were compared between the groups. Results: Our study dataset included 367,894 patients from the NIS database that underwent a THA from 2016 to 2019. 12,900 (3.5 %) patients received a blood transfusion after their THA and were classified as “blood transfusion group.” The remaining 354,994 patients were classified as the “no transfusion group.” Elective admission was found to decrease the odds of a blood transfusion following a THA (compared to nonelective THA: odd's ratio 0.283; p value < 0.001). Multivariate analysis demonstrated sickle cell disease, liver cirrhosis, and dialysis exhibited the greatest increase in odds of blood transfusion after a THA by 4.81- (p < 0.001), 3.02- (p < 0.001), and 2.22-fold (p < 0.001), respectively. Looking at patient demographics, male sex increased odds of postoperative transfusion by 1.99 (p < 0.001) while Caucasian ethnicity decreased odds of postoperative transfusion by 0.65 (p < 0.001). Conclusion: Blood transfusion has a low occurrence in the early post-operative period following THA (3.6 % of patients). Sickle cell disease, liver cirrhosis, dialysis, SLE, and heart pathologies were the comorbidities found to be most significantly associated with an increased risk of blood transfusion after a THA. Additionally, both mortality and non-elective admissions were significantly more prevalent in the “blood transfusion” group.