Blood Transfusion During Total Ankle Arthroplasty is Associated With Increased In-Hospital Complications and Costs

Abstract

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle arthritis and is increasing in utilization. Need for blood transfusion is one potential complication of TAA. While numerous studies have associated blood transfusions with increased complications in hip and knee arthroplasty, little is known of its effect in TAA. This study aims to use a large nationally representative database to determine the effect of blood transfusion on inpatient complications and total hospital costs following TAA. Methods: Using the Nationwide Inpatient Sample (NIS) database from 2002-2012, 19,190 patients undergoing TAA were identified, with 294 (1.5%) receiving a blood transfusion. Univariate analysis was performed to determine patient and hospital factors associated with blood transfusion during inpatient stay following TAA. Multivariate analysis was performed to determine if blood transfusion was associated with other inpatient complications after controlling for age, race, gender, and comorbidities. Results: Patients receiving a blood transfusion were more likely to be older, female, African American race, on Medicaid insurance, and in a non-teaching hospital. The average length of stay for patients undergoing blood transfusion was 5.4 days compared to 2.5 days for those who did not (P < 0.001), while the average inpatient cost was $101,214.77 vs. $58,076.23. Blood transfusion was associated (P < 0.001) with acute renal failure, acute myocardial infarction, pneumonia, length of stay and inpatient cost greater than 75th percentile. After controlling for age, race, gender, and comorbidities, blood transfusion was determined to be an independent risk factor for acute renal failure (P=0.001, OR=3.17), acute myocardial infarction (P < 0.001, OR=66.76), extended length of stay (P < 0.001, OR=5.82), and increased inpatient cost (P < 0.001, OR=2.68). Conclusion: Peri-operative blood transfusions are associated with increased inpatient complications and increased hospital costs following total ankle arthroplasty. Careful preoperative assessment and medical optimization of these patients should be performed in order minimize the risk of peri-operative blood transfusion.