Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors



Accurate identification of patients at risk of blood transfusion can reduce complications and improve institutional resource allocation. Probabilistic models are used to detect risk factors and formulate patient blood management strategies. Whether these predictors vary among institutions is unclear. We aimed to identify risk factors among our patients who underwent total hip (THA) or knee (TKA) arthroplasty, and combine these predictors to improve our model.

Materials and methods

We retrospectively assessed risk factors among 531 adults who underwent elective THA or TKA from January 2016 to November 2018. Using relevant surgical and patient characteristics gathered from electronic medical records, we conducted univariable and multivariable analyses. For our logistic regression model, we measured the impact of independent variables (age, gender, operation type (THA or TKA) and preoperative hemoglobin concentration) on the need for a transfusion.


Of the 531 patients, 321 had THA (uncemented) and 210 had TKA. For the selected period, our transfusion rate of 8.1% (10.6% THA and 4.3% TKA) was low. Univariable analyses showed that lower BMI (p < 0.001) was associated with receiving a transfusion. Important factors identified through logistic regression analyses were age (estimated effect of an interquartile range increase in age: OR 3.89 [CI 95% 1.96–7.69]), TKA (OR − 0.77 [CI 95% − 1.57–0.02]), and preoperative hemoglobin levels (estimated effect of interquartile range increase in hemoglobin: OR 0.47 [CI 95% 0.31–0.71]). Contrary to findings from previous reports, gender was not associated with transfusion.


Previously published predictors such as advanced age, low preoperative hemoglobin, and procedure type (THA) were also identified in our analysis. However, gender was not a predictor, and BMI showed the potential to influence risk. We conclude that, when feasible, the determination of site-specific transfusion rates and combined risk factors can assist practitioners to customize care according to the needs of their patient population.

Level of evidence

Level 3, retrospective cohort study

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The authors received no financial support for the research or authorship of this article.

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Conceptualization: AD, RZ; methodology: AD, NG, JW; formal analysis and investigation: HE, JW; writing—original draft preparation: AD, JW, HE; writing—review and editing: MPS, TAN, RZ; funding acquisition: n/a; resources: AD.

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Correspondence to Alexander Dullenkopf.

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The authors declare that they have no conflict of interest.

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This retrospective medical record review involving human participants was carried out in accordance with the standards of the cantonal ethics committee and with the 1964 Helsinki Declaration and its later amendments. Written consent of the patients whose data were used to conduct the analyses was waived based on the study design.

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Erben, HC., Hess, F., Welter, J. et al. Perioperative blood transfusions in hip and knee arthroplasty: a retrospective assessment of combined risk factors. Arch Orthop Trauma Surg (2021).

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  • Hip arthroplasty
  • Knee arthroplasty
  • Blood transfusion
  • Patient blood management
  • Risk assessment