Blood management after total joint arthroplasty in the United States: 19-year trend analysis

BACKGROUND Recent studies have failed to show reductions in rates of red blood cell (RBC) transfusion after total joint arthroplasty (TJA) in the United States. This study aims to report the 19‐year trend analysis of blood use in TJA, to determine predictors of RBC transfusion and association between RBC transfusion and in‐hospital mortality after TJA using a nationally representative database. STUDY DESIGN AND METHODS Nationwide inpatient sample (NIS) data from 1993 to 2011 were used. ICD‐9‐CM codes were used to identify TJA cases, RBC transfusion, autologous blood transfusion, and/or transfusion from cell salvage. Logistic regression analysis was performed to determine predictors of RBC transfusion and if transfusion increases risk of in‐hospital mortality. RESULTS A total of 2,225,054 TJA cases were identified. Using multivariate analysis, there was an increase in the rate of RBC transfusion over the study period (odds ratio [OR], 1.049; 95% confidence interval [CI], 1.048‐1.050; p