Transfusion after total knee arthroplasty can be predicted using the machine learning algorithm



A blood transfusion after total knee arthroplasty (TKA) is associated with an increase in complication and infection rates. However, no studies have been conducted to predict transfusion after TKA using a machine learning algorithm. The purpose of this study was to identify informative preoperative variables to create a machine learning model, and to provide a web-based transfusion risk-assessment system for clinical use.


This study retrospectively reviewed 1686 patients who underwent TKA at our institution. Data for 43 preoperative variables, including medication history, laboratory values, and demographic characteristics, were collected. Variable selection was conducted using the recursive feature elimination algorithm. The transfusion group was defined as patients with haemoglobin (Hb) < 7 g/dL after TKA. A predictive model was developed using the gradient boosting machine, and the performance of the model was assessed by the area under the receiver operating characteristic curve (AUC). Data sets from an independent institution were tested with the model for external validation.


Of the 1686 patients who underwent TKA, 108 (6.4%) were categorized into the transfusion group. Six preoperative variables were selected, including preoperative Hb, platelet count, type of surgery, tranexamic acid, age, and body weight. The predictive model demonstrated good predictive performance using the six variables [AUC 0.842; 95% confidence interval (CI) 0.820–0.856]. Performance was also good according to the external validation using 400 data from an independent institution (AUC 0.880; 95% CI 0.844–0.910). This web-based blood transfusion risk-assessment system can be accessed at


A web-based predictive model for transfusion after TKA using a machine learning algorithm was developed using six preoperative variables. The model is simple, has been validated, showed good performance, and can be used before TKA to predict the risk of transfusion and guide appropriate precautions for high-risk patients.

Level of evidence

Diagnostic level II.

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This study used clinical data retrieved from Seoul National University Hospital Patients Research Environment (SUPREME) system. The authors wish to thank Kyunga Ko for help with statistics and proofreading the manuscript as well as Professor Yong Seuk Lee and Tae Woo Kim in Bundang Seoul National University Hospital for help with data collection.



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Correspondence to Du Hyun Ro.

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This study was approved by the institutional review board of Seoul National University College of Medicine, Seoul National University Hospital (IRB No. H-1810-133-982).

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Changwung Jo and Sunho Ko contributed equally to this work.

Taehoon Ko and Du Hyun Ro contributed equally to this work.

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Jo, C., Ko, S., Shin, W.C. et al. Transfusion after total knee arthroplasty can be predicted using the machine learning algorithm. Knee Surg Sports Traumatol Arthrosc 28, 1757–1764 (2020).

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  • Machine learning
  • Transfusion
  • Prediction
  • Arthroplasty
  • Predictive model
  • Artificial intelligence