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Analysis of complication rates following perioperative transfusion in shoulder arthroplasty.
J Shoulder Elbow Surg. 2017 Jul; 26(7):1203-1209.JS

Abstract

BACKGROUND

Postoperative anemia requiring a blood transfusion is not uncommon following anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). However, the potential complications in patients undergoing transfusion after shoulder arthroplasty remain unclear. The goal of this study was to examine the postoperative outcomes of patients receiving blood transfusions following TSA and RTSA.

METHODS

Using the Medicare Standard Analytic Files database, we identified all patients undergoing TSA or RTSA between 2005 and 2010. Using International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology codes, we identified the procedure, transfusion status, comorbidities, and postoperative complications of interest. Odds ratios and 95% confidence intervals were calculated.

RESULTS

We identified 7,794 patients who received a perioperative blood transfusion following TSA or RTSA, as well as 34,293 age- and gender-matched controls, during the study period. Patients who received a perioperative transfusion had statistically significantly higher rates of myocardial infarction, pneumonia, systemic inflammatory response syndrome or sepsis, venous thromboembolic events, and cerebrovascular accidents at all time points in question. Patients who received a blood transfusion also showed an increased incidence of surgical complications, including periprosthetic infection and mechanical complications, up to 2 years postoperatively.

CONCLUSION

To our knowledge, this represents the largest study to examine the relationship between the need for perioperative blood transfusion and postoperative medical and surgical outcomes following TSA and RTSA. The results observed in this study highlight the importance of preoperative counseling and medical optimization prior to shoulder arthroplasty, particularly in patients with preoperative anemia or multiple medical comorbidities.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address: grant.garrigues@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28153684

Citation

Grier, A Jordan, et al. "Analysis of Complication Rates Following Perioperative Transfusion in Shoulder Arthroplasty." Journal of Shoulder and Elbow Surgery, vol. 26, no. 7, 2017, pp. 1203-1209.
Grier AJ, Bala A, Penrose CT, et al. Analysis of complication rates following perioperative transfusion in shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(7):1203-1209.
Grier, A. J., Bala, A., Penrose, C. T., Seyler, T. M., Bolognesi, M. P., & Garrigues, G. E. (2017). Analysis of complication rates following perioperative transfusion in shoulder arthroplasty. Journal of Shoulder and Elbow Surgery, 26(7), 1203-1209. https://doi.org/10.1016/j.jse.2016.11.039
Grier AJ, et al. Analysis of Complication Rates Following Perioperative Transfusion in Shoulder Arthroplasty. J Shoulder Elbow Surg. 2017;26(7):1203-1209. PubMed PMID: 28153684.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Analysis of complication rates following perioperative transfusion in shoulder arthroplasty. AU - Grier,A Jordan, AU - Bala,Abiram, AU - Penrose,Colin T, AU - Seyler,Thorsten M, AU - Bolognesi,Michael P, AU - Garrigues,Grant E, Y1 - 2017/01/30/ PY - 2016/07/23/received PY - 2016/11/21/revised PY - 2016/11/25/accepted PY - 2017/2/6/pubmed PY - 2018/2/21/medline PY - 2017/2/4/entrez KW - Total KW - arthroplasty KW - complications KW - database KW - replacement KW - reverse KW - shoulder KW - transfusion SP - 1203 EP - 1209 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 26 IS - 7 N2 - BACKGROUND: Postoperative anemia requiring a blood transfusion is not uncommon following anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). However, the potential complications in patients undergoing transfusion after shoulder arthroplasty remain unclear. The goal of this study was to examine the postoperative outcomes of patients receiving blood transfusions following TSA and RTSA. METHODS: Using the Medicare Standard Analytic Files database, we identified all patients undergoing TSA or RTSA between 2005 and 2010. Using International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology codes, we identified the procedure, transfusion status, comorbidities, and postoperative complications of interest. Odds ratios and 95% confidence intervals were calculated. RESULTS: We identified 7,794 patients who received a perioperative blood transfusion following TSA or RTSA, as well as 34,293 age- and gender-matched controls, during the study period. Patients who received a perioperative transfusion had statistically significantly higher rates of myocardial infarction, pneumonia, systemic inflammatory response syndrome or sepsis, venous thromboembolic events, and cerebrovascular accidents at all time points in question. Patients who received a blood transfusion also showed an increased incidence of surgical complications, including periprosthetic infection and mechanical complications, up to 2 years postoperatively. CONCLUSION: To our knowledge, this represents the largest study to examine the relationship between the need for perioperative blood transfusion and postoperative medical and surgical outcomes following TSA and RTSA. The results observed in this study highlight the importance of preoperative counseling and medical optimization prior to shoulder arthroplasty, particularly in patients with preoperative anemia or multiple medical comorbidities. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/28153684/Analysis_of_complication_rates_following_perioperative_transfusion_in_shoulder_arthroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1058-2746(16)30612-7 DB - PRIME DP - Unbound Medicine ER -