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 Adult Hip Reconstruction Test 5: Perioperative Practices/Outcomes
CME 1: January, February, March 2004
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The Journal of Bone and Joint Surgery (American) 86:57-61 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Clinical Factors Associated with an Increased Risk of Perioperative Blood Transfusion in Nonanemic Patients Undergoing Total Hip Arthroplasty

Enrico Pola, MD1, Pierangelo Papaleo, MD1, Angelo Santoliquido, MD1, Giorgio Gasparini, MD1, Lorenzo Aulisa, MD1 and Ernesto De Santis, MD1

1 Departments of Orthopedics (E.P., G.G., L.A., and E.DeS.) and Medicine (P.P. and A.S.), Università Cattolica del Sacro Cuore School of Medicine, A. Gemelli University Hospital, L.go A. Gemelli 8, 00168 Rome, Italy. E-mail address for E. Pola: enricopola{at}hotmail.com

Investigation performed at the Departments of Orthopedics and Medicine, Università Cattolica del Sacro Cuore School of Medicine, A. Gemelli University Hospital, Rome, Italy

The authors did not receive grants or outside funding in support of their research or preparation of this work. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: The aim of this study was to identify clinical factors associated with an increased need for perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty.

Methods: We evaluated eighty-five consecutive nonanemic patients who underwent elective, unilateral, cementless, primary total hip arthroplasty and met our inclusion criteria. We attempted to determine whether clinical parameters influencing perioperative blood loss, such as age, gender, hypertension, and body mass index, were also associated with the need for perioperative blood transfusion.

Results: Perioperative blood transfusion was required in twenty-four (28%) of the eighty-five nonanemic patients. When considered alone, age, gender, hypertension, and body mass index were not significantly associated with an increased risk of perioperative blood transfusion, on the basis of the numbers available. In contrast, there was a significantly increased risk of blood transfusion when two or more of these clinical parameters were present (p = 0.02).

Conclusions: Our findings indicate that clinical variables such as age, gender, hypertension, and body mass index may have a synergistic effect on the risk of transfusion in patients undergoing elective total hip arthroplasty. The simultaneous analysis of these parameters might help to stratify patients with different risks for transfusion and may increase the efficiency and reduce the cost of blood-ordering practices associated with total hip arthroplasty.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.


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P. J. Millett, M. Porramatikul, N. Chen, D. Zurakowski, and J. J.P. Warner
Analysis of Transfusion Predictors in Shoulder Arthroplasty
J. Bone Joint Surg. Am., June 1, 2006; 88(6): 1223 - 1230.
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