Perioperative Medicine  |   August 2017
Predicting Perioperative Transfusion in Elective Hip and Knee Arthroplasty: A Validated Predictive Model
Author Notes
  • From the Division of Aged Care, Rehabilitation and Palliative Care, Modbury Hospital, Modbury, South Australia, Australia (J.T.); School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia (J.T.); Blood, Organ and Tissue Programs, Public Health and Clinical Systems, Department of Health, Adelaide, South Australia, Australia (R.S.); Faculty of Health Sciences (R.S.) and Flinders Centre for Epidemiology and Biostatistics, School of Medicine (S.W.K.), Flinders University, Bedford Park, South Australia, Australia; South Australia Bloodsafe Program, Adelaide, Australia (K.R.); Queen Elizabeth Hospital, Woodville, South Australia, Australia (K.R.); Departments of Haematology (B.K.) and Orthopaedics and Trauma (D.H.), Clinical Haematology Service (L.B.T.), and Clinical Section (L.B.T.), Royal Adelaide Hospital, Adelaide, South Australia, Australia; and Discipline of Orthopaedics and Trauma (D.H.) and Clinical Pathology (L.B.T.), University of Adelaide, Adelaide, South Australia, Australia.
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    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication October 11, 2016. Accepted for publication April 6, 2017.
    Submitted for publication October 11, 2016. Accepted for publication April 6, 2017.×
  • Address correspondence to Ms. To: Education Centre Modbury Hospital, P.O. Box 550, Modbury, South Australia 5092, Australia. josephine.to@sa.gov.au. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Coagulation and Transfusion
Perioperative Medicine   |   August 2017
Predicting Perioperative Transfusion in Elective Hip and Knee Arthroplasty: A Validated Predictive Model
Anesthesiology 8 2017, Vol.127, 317-325. doi:10.1097/ALN.0000000000001709
Anesthesiology 8 2017, Vol.127, 317-325. doi:10.1097/ALN.0000000000001709
Abstract

Background: Preoperative anemia is a significant predictor of perioperative erythrocyte transfusion in elective arthroplasty patients. However, interactions with other patient and procedure characteristics predicting transfusion requirements have not been well studied.

Methods: Patients undergoing elective primary total hip arthroplasty or total knee arthroplasty at a tertiary hospital in Adelaide, South Australia, Australia, from January 2010 to June 2014 were used to identify preoperative predictors of perioperative transfusion. A logistic regression model was developed and externally validated with an independent data set from three other hospitals in Adelaide.

Results: Altogether, 737 adult patients in the derivation group and 653 patients in the validation group were included. Binary logistic regression modeling identified preoperative hemoglobin (odds ratio, 0.51; 95% CI, 0.43 to 0.59; P < 0.001 for each 1 g/dl increase), total hip arthroplasty (odds ratio, 3.56; 95% CI, 2.39 to 5.30; P < 0.001), and females 65 yr of age and older (odds ratio, 3.37; 95% CI, 1.88 to 6.04; P = 0.01) as predictors of transfusion in the derivation cohort.

Conclusions: Using a combination of patient-specific preoperative variables, this validated model can predict transfusion in patients undergoing elective hip and knee arthroplasty. The model may also help to identify patients whose need for transfusion may be decreased through preoperative hemoglobin optimization.