Preoperative Anemia is an Independent Risk Factor for Increased Complications and Mortalities After Total Knee Arthroplasty Regardless of Postoperative Transfusions

Background: Preoperative anemia is associated with adverse events following total knee arthroplasty (TKA). It remains unknown if this effect is due to comorbid conditions, adverse events associated with transfusions, or the anemia itself. We used propensity-score matching to isolate the effect of anemia on postoperative complications following TKA, regardless of blood transfusions. Methods: Patients undergoing primary TKA from 2010 to 2020 without receiving a perioperative blood transfusion, were identified using a large national database. A 1:1 propensity score matching was used to create cohorts of anemic and nonanemic patients matched on Charlson Comorbidity Index (CCI), American Society of Anesthesiology (ASA) classification, age, sex, and prevalence of bleeding disorders. There were 43,370 patients were included in each group (mean age 68 [range, 29 to 99; 44% male]). The 1:1 matching yielded groups with similar CCI, ASA classification, age, sex, and prevalence of bleeding disorders (all, P >.9). Results: Anemic patients had a higher incidence of major complications (4.1 versus 2.8%; P <.001), 30-day mortality rate (0.2 versus 0.1%; P <.001), and extended lengths of stay (LOS) (8.3 versus 6.6%; P <.001). Anemic patients also had increased 30-day rates of wound infection requiring hospital admission, renal failure, reintubation, myocardial infarction, and pneumonia (all, P <.001). Conclusion: In matched cohorts of anemic versus nonanemic patients undergoing TKA, all who had no postoperative blood transfusion, anemic patients had higher rates of complications, extended LOS, and mortalities. Thus, anemia should be considered an independent risk factor for complications following TKA.