Sershon et al reported risk factors for transfusion in patients undergoing a revision total hip arthroplasty. The authors are from multiple institutions in the United States.
Patient selection: revision total hip arthroplasty
Risk factors for transfusion:
(1) lower preoperative hemoglobin (OR 0.56)
(2) higher preoperative INR (OR 2.58)
(3) longer operative time in hours (OR 1.74)
(4) failure to use tranexamic acid
Increase in chance of transfusion:
(1) increase 79% for each 1 g/dL decrease in hemoglobin
(2) increase 158% for each 0.1 increase in INR
(3) increase 74% for each additional hour of operative time
Maximum reduction in blood utilization requires:
(1) use of modern protocols to reduce transfusion, including use of tranexamic acid if possible
(2) correction of hemoglobin and INR prior to surgery
(3) keeping surgical duration as short as possible
