Nichols Christine I, Vose Joshua G
Medical Affairs, Medtronic Advanced Energy, Portsmouth, New Hampshire.
J Arthroplasty. 2016 Mar;31(3):583-9.e1. doi: 10.1016/j.arth.2015.10.013. Epub 2015 Oct 26.
This study evaluated the comparative risk of autologous and allogenic blood transfusion, inhospital complications, and incremental total hospitalization costs for primary unilateral, simultaneous bilateral, and revision total knee arthroplasty (TKA) procedures.
Using the Premier Perspective database, we identified adults who underwent primary unilateral, simultaneous bilateral, or revision TKA procedures. Logistic regression, controlling for patient and hospital characteristics, was used to determine the risk of autologous or allogeneic blood transfusion. Controlling for the same factors, generalized linear models predicted incremental total hospitalization cost associated with transfusion.
Between January 2008 and June 2014, 513,558 primary unilateral, 33,977 bilateral, and 32,494 revision TKA patients met selection criteria. The overall percentage receiving a transfusion was 14.1% for unilateral, 36.3% for bilateral, and 20.0% for revision procedures. Logistic regression showed patients aged >65 years, female gender, Northeastern location, large hospitals, and higher Charlson score to be significantly associated with higher transfusion risk. Although overall risk of transfusion decreased over the study period, patients with Charlson score ≥3 were at 2.27 (primary unilateral), 1.88 (bilateral), and 2.44 (revision) greater odds of transfusion compared with healthy controls (Charlson score = 0). Generalized linear models showed an incremental total hospitalization cost among those receiving a transfusion of $2477, $4235, and $8594, respectively, compared with those without transfusion.
Transfusion risk remains a significant burden in select patient populations and procedures. The incremental cost of receiving a transfusion is significant, including not only direct costs but also staff time and increased hospital resource use.
本研究评估了初次单侧、同期双侧及翻修全膝关节置换术（TKA）中自体输血和异体输血的相对风险、住院并发症以及住院总费用的增加情况。
利用Premier Perspective数据库，我们确定了接受初次单侧、同期双侧或翻修TKA手术的成年人。采用逻辑回归分析，控制患者和医院特征，以确定自体或异体输血的风险。在控制相同因素的情况下，广义线性模型预测了与输血相关的住院总费用增加情况。
在2008年1月至2014年6月期间，513,558例初次单侧、33,977例双侧和32,494例翻修TKA患者符合入选标准。单侧手术接受输血的总体比例为14.1%，双侧为36.3%，翻修手术为20.0%。逻辑回归显示，年龄>65岁、女性、位于东北部、大型医院以及较高的Charlson评分与较高的输血风险显著相关。尽管在研究期间输血的总体风险有所下降，但Charlson评分为≥3的患者与健康对照组（Charlson评分为0）相比，输血的几率分别高2.27倍（初次单侧）、1.88倍（双侧）和2.44倍（翻修）。广义线性模型显示，与未输血者相比，接受输血者的住院总费用分别增加2477美元、4235美元和8594美元。
输血风险在特定患者群体和手术中仍然是一个重大负担。接受输血的额外费用很高，不仅包括直接费用，还包括工作人员时间和医院资源使用的增加。
