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Trends, complications, and readmission of allogeneic red blood cell transfusion in primary total hip arthroplasty in china: a national retrospective cohort study

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Decrease in allogenic red blood cell (RBC) transfusion rates following total hip arthroplasty (THA) has been reported in the United States, but whether other countries share the same trend remains unclear. Additionally, the relation of allogenic RBC transfusion to the risk of complications in THA remains controversial. Using the Chinese national inpatient database, the current study aimed to examine trends, complications, charges, and readmission patterns of allogeneic RBC transfusion in THA.

Materials and methods

Patients undergoing primary THA between 2013 and 2019 were included, and then stratified into the transfusion and the non-transfusion group based on the database transfusion records. A generalized estimating equation model was used to investigate trends in transfusion rates. After propensity-score matching, a logistic regression model was used to compare the complications, rates and causes of 30-day readmission between two groups.

Results

A total of 10,270 patients with transfusion and 123,476 patients without transfusion were included. Transfusion rates decreased from 19.11% in 2013 to 9.94% in 2019 (P for trend < 0.001). After matching, no significant differences in the risk of of in-hospital death (odds ratio [OR], 4.00; 95% confidence interval [CI] 0.85–18.83), wound infection (OR 0.72; 95%CI 0.45–1.17), myocardial infarction (OR 1.17; 95%CI 0.62–2.19), deep vein thrombosis (OR 1.25; 95%CI 0.88–1.78), pulmonary embolism (OR 2.25; 95%CI 0.98–5.17), readmission rates (OR 1.07; 95%CI 0.88–1.30) and readmission causes were observed between two groups. However, the transfusion group had higher hospitalization charges than the non-transfusion group (72,239.89 vs 65,649.57 Chinese yuan [CNY], P < 0.001).

Conclusions

This study found that allogeneic RBC transfusion in THA was not associated with the increased risk of complications and any-cause readmission. However, the currently restrictive transfusion policy should be continued because excessive blood transfusion may increase the socioeconomic burden.

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Data availability

No data is available. While we are unable to share the data sets, code lists are available on request.

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Acknowledgements

We would appreciate Ying Shi and Zhiye Zhou for their contribution in data collection.

Funding

This work was supported by the National Key Research and Development Plan (2022YFC3601900 and 2022YFC2505500), the National Natural Science Foundation of China (81930071, 82072502, and U21A20352), the Science and Technology Program of Hunan Province (2019RS2010 and 2023JJ41003), the Key Research and Development Program of Hunan Province (2021SK2017), and the Central South University Innovation-Driven Research Programme (2023CXQD031).

Author information

Author notes

  1. Qiao Jiang and Yuqing Wang contributed equally to this manuscript and were considered co-first authors.

Authors and Affiliations

  1. Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Qiao Jiang, Yuqing Wang, Dongxing Xie, Chao Zeng & Guanghua Lei

  2. Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China

    Jie Wei

  3. Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China

    Jie Wei, Xiaoxiao Li, Chao Zeng, Guanghua Lei & Tuo Yang

  4. Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Jie Wei & Tuo Yang

  5. Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan, China

    Chao Zeng & Guanghua Lei

  6. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

    Chao Zeng & Guanghua Lei

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Contributions

QJ: This author helped manuscript writing, data collection, data analysis, study conceive, study design, data interpretation, and project coordination. YW: This author helped manuscript writing, data collection, data analysis, study conceive, study design, data interpretation, and project coordination. DX: This author helped project administration, manuscript writing, data collection, data analysis, study conceive, and study design. JW: This author helped project administration, manuscript writing, data collection, data analysis, study conceive, and study design. XL: This author helped manuscript writing, data collection, data analysis, and, data interpretation. CZ: This author helped data collection, data analysis, data interpretation, and study design. GL: This author helped project administration, data curation, validation, and supervision. TY: This author helped manuscript writing, project administration, data analysis, study conceive, study design, and supervision.

Corresponding author

Correspondence to Tuo Yang.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. This study was authorized by the HQMS Committee Board and approved by the institutional review board of Xiangya hospital (2017121016).

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There is wavier of consent to publication from institutional review board of Xiangya hospital as all data were retrospectively collected with information anonymized. The submission does not include information or images that may identify any person.

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Jiang, Q., Wang, Y., Xie, D. et al. Trends, complications, and readmission of allogeneic red blood cell transfusion in primary total hip arthroplasty in china: a national retrospective cohort study. Arch Orthop Trauma Surg 144, 483–491 (2024). https://doi.org/10.1007/s00402-023-05051-1

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