Transfusion and Inpatient Outcomes In Elective Total Hip Replacement (THR) or Total Knee Replacement (TKR) Surgery Among Adults <65 Years of Age

THR/TKR surgery can be accompanied by high blood loss and need for transfusion in the perioperative period. This claims-based analysis describes the use of blood transfusion and selected clinical and economic outcomes in elective THR/TKR surgery patients <65 years of age.

Patients aged 18 to 64 years with a THR/TKR surgery claim (index) between 1/1/06 and 12/31/08 were identified in the Thomson Reuters MarketScan^® Commercial and Medicare Supplemental Databases. Eligible patients had continuous health plan enrollment for ≥6 months before the index surgery admission and ≥6 months following surgery discharge. Patients were excluded if their surgery was associated with multiple joint procedures, revision surgery, or trauma diagnosis. Patients with a claim for myelosdysplastic syndrome, chronic kidney disease, renal dialysis, human immunodeficiency virus infection, cancer, chemotherapy, sickle cell anemia, or a hospitalization or emergency room visit 6 months before surgery were excluded. Patients were categorized into 2 groups based on transfusion status during index surgery stay. The transfused (T) group had a blood transfusion claim while the non-transfused (NT) did not. The outcomes evaluated included the proportion of patients with an infection claim (wound site infection, pneumonia, urinary tract infection, Clostridium difficile, septicemia, or other), transfusion, transfusion reaction (TR), length of stay (LOS), intensive care unit (ICU) stay, discharge destination, and inpatient costs. Descriptive statistics were used to assess mean, median, and standard deviation (SD). Differences between T and NT groups were assessed by chi-square or two-sample t-tests.

A total of 64,014 patients met the study criteria. Mean age of the population was 56.1 ± 6.1 years, 57% were female, and 99% were insured. The mean LOS was 4.3 days. Median inpatient cost was US$24,027. During THR/TKR admission, 3.4% of patients had an ICU stay and 2.4% had an infection claim. The majority of patients (82%) were discharged home (45.9% with self-care; 35.8% required home health services), 10% were transferred to another facility, and 8% had unknown or other destinations. A transfusion claim was found in 8.3% of patients (n=5,302), and of these, 0.2% (n=11) had a TR claim. As reported in the table below, comparisons of outcomes between T and NT groups revealed differences in LOS, proportion of patients with an infection, proportion of patients with an ICU stay, and discharge destination. Median inpatient costs were $26,906 and $23,780 for T and NT groups, respectively.

This retrospective claims-based analysis describes outcome parameters associated with inpatient THR/TKR surgery patients <65 years of age. The group with a transfusion claim was observed to have longer LOS, a higher proportion of patients with documented infection, ICU stay, post-surgery supportive care, and higher cost as compared to patients without a transfusion claim. Additional research to substantiate these findings in the overall THR/TKR population is warranted.

Ellis:Centocor Ortho Biotech Services, LLC: Employment. Bailey:Centocor Ortho Biotech Services, LLC: Employment. Forlenza:Centocor Ortho Biotech Services, LLC: Employment. Senbetta:Centocor Ortho Biotech Services, LLC: Employment. Landsman-Blumberg:Centocor Ortho Biotech Services, LLC: Consultancy, Research Funding.