Abstract
Introduction
Previous hemodynamics studies in shoulder arthroplasty only evaluated Western population and mainly focused on risk factors of transfusion. However, Asians are relatively small, and have higher bleeding risk due to prothrombin-clotting-factor polymorphisms. Therefore, it is not appropriate to apply the results of previously studies directly to Asians. Authors compare different hemodynamics depending on the types of shoulder arthroplasties, and evaluate predictors for transfusion in Asian population.
Methods
Total 212 shoulder arthroplasties (26 fracture hemiarthroplasty (fHA), 49 anatomical total shoulder arthroplasty (aTSA), 132 reverse total shoulder arthroplasty (rTSA), and 5 revision surgery) from August 2004 to January 2016 were retrospectively reviewed. Demographics, surgical factors and perioperative hemodynamic factors were compared for each type of arthroplasty. Multivariate regression analysis was conducted to determine predictors for transfusion.
Results
Preoperative Hb and Hct level were lower in fHA group (11.9 ± 1.8g/dL, 35.1 ± 5.4%; p < 0.001, 0.001). Total drain output was higher in rTSA and revision (349.1 ± 191.7mL, 408.6 ± 125.8mL; p<0.001, <0.001), however, there was no significant difference of estimated blood loss (p=0.269). There was significant, but very weak correlation between drain output with Hb decrease in postoperative one day (r = 0.192; p = 0.007). However, there were not significant correlation between drain output with Hb decrease after postoperative 2 and 3 days (r = 0.185, 0.001; p = 0.241, 0.997). The overall transfusion rate was 11.3% (24/212); fHA 30.8% (8/26), aTSA 10.2% (5/49), rTSA 7.6% (10/132), revision 20% (1/5). In multivariate regression analysis, lower Hb level of preoperative period and postoperative 1 day were predictors for transfusion (OR = 0.481, 0.499; p = 0.002, 0.017) and cutoff-value were 12.15g/dL and 10.0g/dL, respectively (OR = 7.404, 5.499; p = <0.001, 0.001; Sensitivity=80%, 70%; Specificity=80%, 84%).
Conclusion
In Asian, overall transfusion rate after shoulder arthroplasties was 11.3%, varied by type of arthroplasty. Lower Hb level of preoperative period (<12.15g/dL) and postoperative 1 day (<10.0g/dL) were predictors for transfusion. Surgeons should consider different hemodynamics depending on different types of shoulder arthroplasty, and close monitoring of perioperative Hb level is essential to decrease hemorrhage-related complications, because drain output could not represent perioperative hemorrhage.
