Blood Transfusion Trends in Primary and Revision Total Joint Arthroplasty: Recent Declines Are Not Shared Equally

Introduction: This study examined whether recent nationwide declines in the incidence of transfusion following total joint arthroplasty were equal across inpatient facilities. Methods: This analysis used the Premier database (2010 to 2015). Cohorts of primary total hip or knee arthroplasty (THA or TKA) and revision THA or TKA were defined. Results: Among 1,013,024 patients who met selection criteria, the overall incidence of transfusion declined from 2010 through 2015 (primary THA: 22.1% to 7.1%; primary TKA: 18.1% to 3.2%; revision THA: 30.6% to 18.5%; and revision TKA: 19.8% to 9.8%; all P, 0.001). However, patients older than 65 years were associated with lower odds of transfusion relative to those younger than 65 years (P, 0.05 for three of four cohorts); smaller hospitals were associated with higher odds versus large hospitals (P, 0.05 all cohorts), and academic hospitals were associated with higher odds of transfusion versus community facilities (P, 0.05 for three of four cohorts). Discussion: During this study period, a meaningful proportion of total joint arthroplasty procedures were performed at facilities with the most room to improve. Decreases in transfusion rates were dependent on specific hospital characteristics; these results may help direct targeted improvement initiatives.