Investigation performed at the University of Virginia, Charlottesville, Virginia.
J Arthroplasty. 2013 Sep;28(8 Suppl):34-7. doi: 10.1016/j.arth.2013.03.035. Epub 2013 Jul 26.
Despite attempts to minimize exposure to allogeneic blood, there are little data on recent nationwide trends in transfusion following total hip arthroplasty (THA) and no consensus on indications. The purpose of this study was to examine the rate, predictors, and inpatient outcomes associated with transfusion after primary THA. This retrospective cohort study analyzed the data collected from US Nationwide Inpatient Sample (NIS) for each year during the period 2005-2008 to assess the trends in transfusion in patients who underwent elective primary THA. Logistic regression models were used to evaluate the predictive risk factors for blood transfusion. The University Hospital Consortium (UHC) database was also queried to examine the variability in rates of transfusion at different academic medical centers. A total of 129,901 patients were identified in the NIS database. The transfusion rates following THA consistently increased from 18.12% in 2005 to 21.21% in 2008 (P<0.0001). Hospitals in the Northeast and Midwest region had the highest and lowest rates of transfusion, respectively. Significant risk factors for blood transfusion were female gender (odds ratio, OR 2.1), age above 85 (OR 2.9), African-American race (OR 1.7), Medicare payor status (OR 1.6), being at a hospital in the Northeast Region (OR 1.4), the presence of preoperative anemia (OR 1.6), having at least one comorbidity (OR 1.3), and a high Charlson Index score (OR 2.2). Patients receiving blood transfusions had increased in-hospital mortality, longer lengths of stay, and higher total charges compared to non-transfused patients (P<0.001). The UHC database demonstrated that transfusion rates vary widely across different institutions from <5% to >80%. The incidence of blood transfusion has recently increased following total hip arthroplasty and there is great variability in practice. We identified several patient risk factors along with the morbidity and mortality independently associated with transfusion following THA. Further work is needed to standardize the approach to blood conservation and minimize exposure to allogenic blood.
尽管人们试图尽量减少接触异体血液，但关于全髋关节置换术（THA）后输血的最新全国趋势的数据很少，而且对于适应证也没有共识。本研究的目的是研究初次 THA 后输血的发生率、预测因素和住院结局。本回顾性队列研究分析了 2005-2008 年期间美国全国住院患者样本（NIS）每年收集的数据，以评估接受择期初次 THA 的患者输血的趋势。使用逻辑回归模型评估输血的预测风险因素。还查询了大学医院联盟（UHC）数据库，以检查不同学术医疗中心输血率的变化。在 NIS 数据库中确定了 129901 例患者。THA 后输血率从 2005 年的 18.12%持续增加到 2008 年的 21.21%（P<0.0001）。东北地区和中西部地区的医院输血率最高和最低。输血的显著危险因素为女性（比值比，OR 2.1）、年龄超过 85 岁（OR 2.9）、非裔美国人（OR 1.7）、医疗保险支付人状态（OR 1.6）、在东北地区的医院（OR 1.4）、术前贫血（OR 1.6）、至少有一种合并症（OR 1.3）和高 Charlson 指数评分（OR 2.2）。与未输血的患者相比，接受输血的患者住院死亡率增加、住院时间延长且总费用更高（P<0.001）。UHC 数据库显示，不同机构的输血率差异很大，从<5%到>80%不等。THA 后输血的发生率最近有所增加，而且实践中存在很大差异。我们确定了一些患者的危险因素，以及与 THA 后输血相关的发病率和死亡率。需要进一步的工作来规范血液保护方法并尽量减少异体血液的暴露。
