The Impact of Preoperative Co-morbidities on Blood Transfusion Requirements Following Reverse Total Shoulder Arthroplasty

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

Keywords

Main Subjects

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The Archives of Bone and Joint Surgery
Volume 12, Issue 7
July 2024
Pages 487-493

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History

  • Receive Date: 03 April 2024
  • Revise Date: 29 April 2024
  • Accept Date: 29 April 2024

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