# A Retrospective Single-Center Cohort Study on Heme Transfusions in Orthopedic Surgeries

## TL;DR

This study examines blood transfusion practices in orthopedic surgeries and finds that transfusions are linked to worse outcomes and are often given unnecessarily.

## Contribution

The study identifies key predictors of transfusion needs and highlights significant deviations from recommended transfusion guidelines in orthopedic settings.

## Key findings

- Transfusion rates varied widely by procedure type, with complex spinal surgeries having the highest rate at 22.4%.
- Transfused patients had longer hospital stays, higher complication rates, and increased readmission rates compared to non-transfused patients.
- 42% of transfusions were given at hemoglobin levels above 8 g/dL in stable patients, deviating from standard guidelines.

## Abstract

Blood transfusions remain a critical yet potentially hazardous intervention in orthopedic surgical procedures, particularly those associated with substantial blood loss such as joint arthroplasties, spinal surgeries, and complex trauma reconstructions.

This retrospective cohort study, conducted at RL Jalappa Hospital, Kolar, India, from February 2023 to January 2024, comprehensively evaluated transfusion practices across 395 major orthopedic surgeries.

The study revealed an overall transfusion rate of 10.3%, with significant variation across procedure types, ranging from 6.8% in elective arthroplasties to 18.2% in revision surgeries and 22.4% in complex spinal procedures. Multivariate analysis identified several independent predictors of transfusion requirements, including advanced age (>65 years, OR 2.4), preoperative anemia (Hb <10 g/dL, OR 3.2), prolonged surgical duration (>3 hours, OR 2.1), and substantial intraoperative blood loss (>500 mL, OR 4.0). Importantly, transfused patients demonstrated significantly worse clinical outcomes, including extended hospital stays (7.2 vs 4.5 days, p<0.001), higher complication rates (24% vs 8%, p=0.003), particularly surgical site infections (12% vs 4%), and increased 30-day readmission rates (8% vs 3%, p=0.02). The study also evaluated institutional transfusion triggers, finding considerable variability from recommended guidelines, with 42% of transfusions administered at hemoglobin levels of >8 g/dL in hemodynamically stable patients.

These findings underscore the urgent need for standardized, evidence-based transfusion protocols, comprehensive preoperative optimization strategies, and robust blood management programs in orthopedic surgery. The study provides a framework for developing institution-specific guidelines to minimize unnecessary transfusions while optimizing patient outcomes and resource utilization.