Predictors of blood transfusion in patients undergoing total shoulder arthroplasty

Jacob D. Mikula, Matthew J. Best, Keith T. Aziz, Uma Srikumaran

Research output: Contribution to journalArticlepeer-review


Background: Anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty are major surgeries that may result in significant blood loss and the need for transfusion. The purpose of this study was to identify predictors for blood transfusion in patients undergoing TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program was used to identify 12,982 patients who underwent TSA (anatomic or reverse) from January 1, 2011 to December 31, 2016. We compared patients who underwent intraoperative or postoperative blood transfusion with those who did not receive a blood transfusion. Multivariable logistic regression was used to determine independent factors associated with blood transfusion. Results: The rate of intraoperative and postoperative blood transfusion was 3.5% during the study period. Compared with patients who did not receive a blood transfusion, those who did were older (73.4 vs. 68.9 years, P < .001), had longer operative times (137.8 vs. 110.7 minutes, P < .001), had longer hospital stays (3.9 vs. 1.9 days, P < .001), and were more likely to be female (74% vs. 55%, P < .001). Patients who received a blood transfusion had higher mean American Society of Anesthesiologists (ASA) classification score (2.8 vs. 2.5, P < .001). The following factors were independently associated with greater odds of blood transfusion: ASA class 4 (odds ratio [OR] 8.4, 95% confidence interval [CI] 2.0-36), dialysis (OR 2.5, 95% CI 1.0-5.9), bleeding disorders (OR 2.4, 95% CI 1.6-3.5), female sex (OR 1.8, 95% CI 1.4-2.3), and smoking (OR 1.4, 95% CI 1.0-2.0). Patients with independent functional status before surgery were least likely to require blood transfusion (OR 0.5, P < .001). Conclusion: In patients undergoing shoulder arthroplasty, preoperative factors such as ASA classification, smoking, and functional status can be used to identify patients at increased risk for requiring blood transfusion. Level of evidence: Level III.

Original languageEnglish (US)
Pages (from-to)375-379
Number of pages5
JournalSeminars in Arthroplasty
Issue number3
StatePublished - Sep 2021


  • ASA classification
  • Anatomic
  • Blood transfusion
  • Choosing Wisely
  • Postoperative outcomes
  • Reverse
  • Total shoulder arthroplasty
  • Tranexamic acid

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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