Risk Factors for Reaching the Post-Operative Transfusion Trigger in a Community Primary Total Knee Arthroplasty Population

Abstract

BackgroundLittle data exist to evaluate an individual’s pre-operative risk of blood transfusion following total knee arthroplasty (TKA). Our aim is to identify the risk factors associated with reaching the transfusion trigger of Hb <8 g/dL (TT8) following surgery and how perioperative tranexamic acid (TXA) affects that outcome. MethodsUsing a retrospective cohort study design, routine, unilateral TKAs performed between 2011 and 2013 in 19 hospitals were reviewed. Patients hospitalized ≤1 day or ≥4 days were excluded. Demographic data, clinical characteristics, and potential confounders were included in statistical models. Data were abstracted from electronic clinical and utilization databases. The main outcome was the risk of reaching the TT8. The primary exposure was use of single dose intravenous TXA. Logistic regression was used to model the adjusted association between TXA usage and post-operative risk of reaching TT8. ResultsA total of 10,518 TKAs met criteria; 2566 (24.3%) received TXA (+TXA). The proportion that reached the TT8 was 2.1% for + TXA and 5.3% for −TXA (P < .0001). Pre-operative Hb levels were associated with increasing odds of reaching the TT8. Increasing age was weakly associated with this outcome. The odds of reaching the TT8 were lower for patients who had received TXA, had increasing body mass index, and surgical duration in the third quartile. ConclusionNot receiving TXA within 24 hours of TKA and pre-operative Hb levels <13 g/dL were independently associated with the odds of reaching the post-operative TT8 following a primary TKA.