Trends, risk factors, and complications of blood transfusion in primary total knee arthroplasty in China: a nationwide retrospective study

Abstract

Introduction

Identifying risk factors and prognosis associated with red blood cell (RBC) transfusions will be meaningful in establishing effective blood management strategies. We aimed to examine the trends, risk factors, and complications of RBC transfusions in primary total knee arthroplasty (TKA) in China.

Materials and methods

The Hospital Quality Monitoring System was analyzed for patients undergoing primary TKA between 2013 and 2019. Trends in RBC transfusion rates, mean volume and cost were analyzed. Risk factors for transfusion were identified using multivariable logistic regression. After propensity score matching, the effects of transfusion on complications were examined using logistic regression, with the calculation of odds ratio (OR) and 95% confidence interval (CI).

Results

A total of 11,894 transfused patients and 162,349 non-transfused patients were included. Transfusion rates substantially declined from 20.0% in 2013 to 3.0% in 2019 (P for trend < 0.001), accompanied by a continuous decrease in mean volume (3.9 unit [U] to 2.9 U, P for trend < 0.001) and cost (1,021.8 Chinese Yuan [CNY] to 811.1 CNY, P for trend < 0.001) of transfusion. Risk factors for transfusion included older age (OR 1.37; 95%CI 1.24–1.51), female sex (OR 1.30; 95%CI 1.23–1.35), non-osteoarthritis indication (OR 1.57; 95%CI 1.47–1.69), preoperative anemia (OR 3.76; 95%CI 3.11–4.55), higher Charlson Comorbidity Index score (OR 1.16; 95%CI 0.99–1.36), and hospitals in central (OR 1.47; 95%CI 1.41–1.53) and west (OR 1.41; 95%CI 1.34–1.49) regions. On propensity-adjusted analyses, transfusion was associated with higher risk of 30-day readmission (OR 1.25; 95%CI 1.07–1.47) and deep vein thrombosis (OR 1.49; 95%CI 1.22–1.83), and increased costs (66,845.39 vs. 61,263.56 CNY, P < 0.001).

Conclusions

Rates, volumes, and costs of RBC transfusion in TKA have fallen substantially in China. However, several risk factors for transfusion should be recognized and appropriately managed, as RBC transfusion increased complication rates and socioeconomic burden.