Background. Various studies have raised concern of worse outcomes in patients receiving blood transfusions perioperatively\r\ncompared to those who do not. In this study we attempted to determine the proportion of perioperative complications in the\r\northopedic population attributable to the use of a blood transfusion. Methods. Data from 400 hospitals in the United States\r\nwere used to identify patients undergoing total hip or knee arthroplasty (THA and TKA) from 2006 to 2010. Patient and health\r\ncare demographics, as well as comorbidities and perioperative outcomes were compared. Multivariable logistic regression models\r\nwere fitted to determine associations between transfusion, age, and comorbidities and various perioperative outcomes. Population\r\nattributable fraction (PAF) was determined tomeasure the proportion of outcome attributable to transfusion and other risk factors.\r\nResults. Of 530,089 patients, 18.93% received a blood transfusion during their hospitalization. Patients requiring blood transfusion\r\nwere significantly older and showed a higher comorbidity burden. In addition, these patients had significantly higher rates ofmajor\r\ncomplications and a longer length of hospitalization. The logistic regression models showed that transfused patients were more\r\nlikely to have adverse health outcomes than nontransfused patients. However, patients who were older or had preexisting diseases\r\ncarried a higher risk than use of a transfusion for these outcomes. The need for a blood transfusion explained 9.51% (95% CI 9.12ââ?¬â??\r\n9.90) of all major complications. Conclusions. Advanced age and high comorbidity may be responsible for a higher proportion of\r\nadverse outcomes in THA and TKA patients than blood transfusions.
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