Implications of revision total elbow arthroplasty on blood transfusion

Hypothesis

We hypothesize that there is a greater rate of blood transfusions following revision total elbow arthroplasty (TEA) as compared with primary TEA, with lower preoperative hemoglobins and longer operative times being significant risk factors.

Materials and methods

The results of 193 operations (172 patients) between January 2000 and December 2004 were retrospectively reviewed. Excluded were patients with primary impairment of platelet or coagulation function or with chronic liver impairment. Univariate and χ² analyses were used to determine which risk factors were predictive of transfusion.

Results

The transfusion rate was 7.8% for revision arthroplasties and 1.0% after primary procedures (P < .02). Revision surgery (P < .02), longer operative times (P < .01), longer anesthesia times (P < .01), lower preoperative hemoglobin level (10.6±0.5 g/dL; P < .01), and lower body mass index (P=.04) significantly increased the risk of blood transfusion.

Discussion

The need for blood transfusion after revision elbow arthroplasty is statistically greater than that after primary procedures. Furthermore, revision surgery, increased operative and anesthesia times, lower preoperative hemoglobin level, and decreased body mass index increase the risk of requiring a transfusion. Patients undergoing revision surgeries with preoperative hemoglobin levels of less than 10 g/dL are especially at risk of transfusion, and the proper precautions should be enacted during the perioperative period.

Level of evidence: Level IV, Case Series, Treatment Study

Keywords: Total elbow arthroplasty, blood transfusion, revision surgery, operative time, preoperative hemoglobin