Document Type : RESEARCH PAPER
Authors
1
University of Texas Southwestern Medical Center, Dallas, Texas, USA
2
Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
Abstract
Objectives: Reverse total shoulder arthroplasty (RTSA) continues to increase in popularity as a surgical
operation in the United States. As indications for this procedure expand, more attention is needed to
evaluate perioperative risk factors and patient characteristi cs. Postoperative anemia requiring blood
transfusion (BT) is a well-documented risk factor for increased in-house mortality although little has
been studied on the relationship between RTSA and postoperative BT. The purpose of this study was
to identify comorbidities and patient characteristics as risk factors for BT in patient’s undergoing RTSA.
Methods: Using the Nationwide Inpatient Sample (NIS) database, 59,925 RTSA patients (2016-2019) were
analyzed, with 1.96% requiring postoperative BT. Demographics, comorbidities, and preoperative factors were
compared between BT and non-BT groups via univariate and multivariate analyses.
Results: Overall prevalence of blood transfusion in all patients was 1.96%. Male sex (OR 1.75, p < 0.001), Asian
ethnicity (OR 1.96, p = 0.012), age >80 (OR 1.51, p < 0.001), age >90 (OR 2.26, p < 0.001), CKD (OR 1.94, p <
0.001), and Parkinson’s disease (OR 2.08, p < 0.001) were associated with increased BT odds. Cirrhosis exhibited
the highest impact (OR 5.7, p < 0.001). Conversely, Caucasian ethnicity (OR 0.76, p = 0.023), uncomplicated DM
(OR 0.73, p = 0.002), tobacco-related disorders (OR 0.43, p < 0.001), BMI >30 (OR 0.8, p = 0.011), and elective
procedures (OR 0.16, p < 0.001) decreased BT odds.
Conclusion: These results were useful with identifying several risk factors that predispose to a higher risk of
postoperative BT in patients undergoing RTSA including male sex, people of Asian descent, age > 80, CKD,
Parkinson’s disease, and cirrhosis. These findings provide clinicians with information that may be helpful with
preoperative planning and perioperative management of complex patient populations.
Level of evidence: III
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