Incidence and risk factors for perioperative blood transfusion in total knee and hip arthroplasties in Rwanda

Abstract

Introduction: Perioperative transfusion of blood cells in total joints arthroplasty (TJA) continues to present a major concern despite the global strategies to minimize its utilization and related complications developed to improve patients‟ safety and outcomes. This study intends to determine the incidence and identify factors which are associated with perioperative transfusion of PRBCs in unilateral primary total hip and total knee arthroplasties (THA, TKA) in Rwanda. Methods: 133 patients who have undergone either a primary THA or TKA at King Faisal Hospital Rwanda (KFHR) between February/2020 and February/2021 were prospectively analyzed. Patients‟ demographics, preoperative clinical information including diagnoses, comorbidities and laboratory data were recorded preoperatively. Other information about the allogeneic blood transfusion was recorded in intraoperative and postoperative periods before discharge, a 48 hours drain output was also recorded. Statistical analysis was used to determine the incidence and identify the risk factors which are related with utilization of PRBCS transfusion in TJA. Results: A total number of 133 participants are enrolled and included in our analysis, THA were carried out in 92 (69.2%) patients, while 41 (31.8%) were undergone TKA. The overall blood transfusion rate was 41.4 % in total major joints (hip and knee) arthroplasty (p<0.001), 44.6% and 34.2% in THA and TKA (p<0.001) respectively. Factors like hypertension (p<0.001), diabetes mellitus concomitant with hypertension (p<0.001) were associated with high rate of transfusion along with diagnosis of hip osteoarthritis (p<0.001) and neck of femur fracture (p<0.001). A low baseline Hemoglobin (Hb) (p<0.001) level, an increased amount of intraoperative blood loss (p < 0.019) and prolonged length of operation (p<0.001) are attributable to perioperative PRBCs transfusion in THA. The similar factors contributed to PRBCs transfusion in TKA group, in addition with female gender (p<0.001) and diagnosis of knee OA (p<0.001). Conclusion: The overall incidence of blood transfusion in both total hip and knee arthroplasty is slightly high in our settings; anticipation of blood transfusion by treating surgeon should always be considered and correlated with individual patients‟ risk factors attributable to the needs of blood transfusion during or after TJA.