Risk Factors for Blood Transfusions Following Total Joint Arthroplasty in Patients with Rheumatoid Arthritis

Abstract

Background/Purpose: Despite effective therapies, rheumatoid arthritis (RA) can result in joint destruction requiring total joint arthroplasty to maintain patient function. An estimated 16% to 70% of those undergoing total joint arthroplasty of the hip or knee will receive a blood transfusion. Few studies have described risk factors for blood transfusion following total joint arthroplasty in patients with RA. The purpose of this study is to identify demographic and clinical risk factors associated with receiving a blood transfusion following total joint arthroplasty among patients with RA.

Methods: A retrospective study (N = 3,270) was conducted using de-identified patient health claims information from a commercially-insured, U.S. dataset (2007-2009). Data analysis included descriptive statistics and multivariate logistic regression.

Results: Females were more likely to receive a blood transfusion (Odds ratio [OR]=1.48; 95% Confidence Interval [CI]: 1.16-1.87; p=.001). When compared to those in the South, patients residing the Midwest were less likely to receive a blood transfusion following total joint arthroplasty (OR=0.56, 95% CI: 0.44-0.71). Relative to those receiving total knee arthroplasty, patients who underwent total hip arthroplasty were more likely to receive a blood transfusion (OR=1.39, 95% CI: 1.14-1.70), and patients who underwent a total shoulder arthroplasty were less likely to receive a blood transfusion (OR=0.14 and 95% CI: 0.05-0.38; p<.001). Patients with a history of anemia were more likely to receive a blood transfusion compared to those who did not have this diagnosis (OR=3.30, 95% CI: 2.62-4.14; p<.001).

Conclusion: Risk factors for the receipt of blood transfusions among RA patients who have undergone total joint arthroplasty were identified.