The Impact of Preoperative Co-morbidities on Blood Transfusion Requirements Following Reverse Total Shoulder Arthroplasty

Objectives: Reverse total shoulder arthroplasty (RTSA) continues to increase in popularity as a surgical operation in the United States. As indications for this procedure expand, more attention is needed to evaluate perioperative risk factors and patient characteristi cs. Postoperative anemia requiring blood transfusion (BT) is a well-documented risk factor for increased in-house mortality although little has been studied on the relationship between RTSA and postoperative BT. The purpose of this study was to identify comorbidities and patient characteristics as risk factors for BT in patient’s undergoing RTSA.Methods: Using the Nationwide Inpatient Sample (NIS) database, 59,925 RTSA patients (2016-2019) were analyzed, with 1.96% requiring postoperative BT. Demographics, comorbidities, and preoperative factors were compared between BT and non-BT groups via univariate and multivariate analyses.Results: Overall prevalence of blood transfusion in all patients was 1.96%. Male sex (OR 1.75, p 0.001), Asian ethnicity (OR 1.96, p = 0.012), age 80 (OR 1.51, p 0.001), age 90 (OR 2.26, p 0.001), CKD (OR 1.94, p  0.001), and Parkinson’s disease (OR 2.08, p 0.001) were associated with increased BT odds. Cirrhosis exhibited the highest impact (OR 5.7, p 0.001). Conversely, Caucasian ethnicity (OR 0.76, p = 0.023), uncomplicated DM (OR 0.73, p = 0.002), tobacco-related disorders (OR 0.43, p 0.001), BMI 30 (OR 0.8, p = 0.011), and elective procedures (OR 0.16, p 0.001) decreased BT odds.Conclusion: These results were useful with identifying several risk factors that predispose to a higher risk of postoperative BT in patients undergoing RTSA including male sex, people of Asian descent, age 80, CKD, Parkinson’s disease, and cirrhosis. These findings provide clinicians with information that may be helpful with preoperative planning and perioperative management of complex patient populations. Level of evidence: III