Allogeneic Blood Transfusions and Total Hip or Knee Arthroplasty?

Published on: 14 April, 2014

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A recent publication in the Journal of Bone and Joint Surgery provides some interesting data regarding the rates of postoperative infections. With up to 70% of patients who undergo a total hip or knee replacement receiving blood transfusions, the conclusion that infection rates were significantly increased following allogeneic transfusions may bring further attention to this area.

In a level III post-hoc analysis, researchers stratified more that 12,000 patients into three groups: those that received no transfusion (n=6313), autologous blood transfusion (n=1902) and allogeneic blood transfusion (with or without autologous blood transfusion (n=3962). Post-operative infection by type (lower or upper respiratory tract infection, bone and joint infection, wound inflammation or infection, urinary tract infection and other infections) was recorded. The rate of infection was 9.9% in patients with allogeneic transfusions, compared to 7.9% in patients not receiving an allogeneic transfusion. This difference was statistically different (P=0.003).

In a similarly titled paper, also published in JBJS, researchers from Duke University Medical Centre in North Carolina, and the University of California in San Francisco also concluded that perioperative allogeneic transfusion was associated with a higher rate of reoperations for suspected acute infection. 3352 patients were treated with a total hip or knee arthroplasty (1730 total knee and 1622 total hip) and included in the study. 836 cases were given an allogeneic infusion and 910 had an autologous-only infusion. Reoperation rate for suspected infection was higher in the cases with allogeneic exposure (1.67%), compared to 0.72% in those without allogeneic exposure (p = 0.013). When adjusted, however, for total number of units transfused and ASA score, allogeneic exposure was not a significant predictor of reoperation for infection.

Despite these potentially conflicting findings, there is no doubt that hospital-acquired infections, in any form, result in significant costs to the healthcare system. A report in 2009 by the Centre for Disease Control, estimated that the overall annual direct costs of hospital-acquired infections in the US ranged from $28.4 to 33.8 billion. The benefits of prevention range from a low of $5.7 billion to $31.5 billion. These figures certainly warrant the further research and investigation into the possible causes, and more importantly, methods to prevent these infections.

Whilst the number of infections in Australia is difficult to trace, the Australian National Joint Replacement Registry reported 48,783 total knee replacements and 38,432 total hip replacements in 2013. It will be interesting to follow future trends regarding blood transfusions given this increased focus on hospital-acquired infections, and the research that has recently been published.

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