Abstract
Aims
Joint arthroplasties may be associated with a blood loss, which necessitates transfusion. Especially, hip arthroplasties are highly associate with transfusion to compensate perioperative bleeding. Orthopaedic surgeons and patients have increasing concerns regarding complications of blood transfusions. Although various methods to reduce transfusions have been attempted in TJA, a high percentage of patients require a transfusion during and after the procedures. The purposes of this study were to evaluate the trends of the transfusion(transfusion rates, transfusion amounts, economic burden) in hip arthroplasties, using nationwide data from the National Health Insurance Service (NHIS).
Patients and methods
We used data from nationwide claims database of Health Insurance Review Assessment Service (HIRA). The data managed by the NHIS were used to identify the 161,934 hip arthroplasties by 3 categories including bipolar hemiarthroplasty(BH), total hip arthroplasty(THA), and revision arthroplasty(RA) from 2007 to 2015. These 3 categories were classified using the operation code recorded in the requisition data of NHIS. The transfusion rates, transfusion amounts, proportion of transfusion, cost of each type of operation was investigated and stratified by age, gender, hospital type, and area in hip arthroplasties. The proportion of transfusion about whole blood, red blood cell, fresh frozen plasma, platelet, was also evaluated in hip arthroplasties.
Results
The patients of hip arthroplasties who receive transfusion was observed 11,224/13,584 in 2007, 12,823/15,325 in 2008, 13,447/16.144 in 2009, 14,915/17,702 in 2010, 15,623/18,648 in 2011, 16,374/19,878 in 2012, 16,961/20,423 in 2013, 16,367/20,060 in 2014 and 16,116/20,170 in 2015. Total transfusion rate was 81.1% in 9 years data.(82.6% in 2007, 83.7% in 2008, 83.3% in 2009, 84.3% in 2010, 83.8% in 2011, 82.4% in 2012, 83% in 2013, 81.6% in 2014, 79.9% in 2015. The overall proportion of transfusion was 7% fresh frozen plasma, 12% platelet, and 77% RBC. The total amount of transfusion was 47,351 in 2007, 56.387 in 2008, 58,320 in 2009, 66,604 in 2010, 68,472 in 2011, 74,735 in 2012, 73,370 in 2013, 67,736 in 2014, and 62,749 in 2015. The average dose of transfusion is 4.1 times in bipolar hemiarthroplasty(343,815/ 83,729), 8.7 times in revision arthroplasty(35,044/4,024), 4.3 times in total hip arthroplasty from 2007 to 2015.
Conclusion
In this nationally representative study of patterns of transfusion use in hip arthroplasty, we observed relatively high rates in the use of blood transfusion among patients undergoing hip arthroplasties regardless of many factors including patient, hospital, characteristics, compared with researches in other countries. The total amount of transfusion shows decreasing trends recently, however, it does not seem a big difference in transfusion rate.
