Aims. Currently, there is little information about the need for peri-operative
blood transfusion in patients undergoing shoulder arthroplasty. . The purpose of this study was to identify the rate of transfusion
and its predisposing factors, and to establish a blood conservation
strategy. . Methods. We identified all patients who had undergone shoulder arthroplasty
at our hospital between 1 January 2011 and 31 December 2013. The
rate of transfusion was determined from the patient’s records. While
there were exceptions, patients typically underwent transfusion
if they had a level of haemoglobin of <
7.5 g/dl if asymptomatic,
<
9.0 g/dl if they had a significant cardiac history or symptoms
of dizziness or light headedness. . Multivariable regression analysis was undertaken to identify
predictors of transfusion. High- and low-risk cohorts for transfusion
were identified from a receiver operating characteristic (ROC) curve. Results. Of 1174 shoulder arthroplasties performed on 1081 patients, 53
cases (4.5%) required transfusion post-operatively. Predictors of
blood transfusion were a lower pre-operative haematocrit (p <
0.001) and shoulder arthroplasty undertaken for post-traumatic arthritis
(p <
0.001). ROC analysis identified pre-operative haematocrit
of 39.6% as a 90% sensitivity cut-off for transfusion. In total
48 of the 436 (11%) shoulder arthroplasties with a pre-operative haematocrit
<
39.6% needed transfusion compared with five of the 738 (0.70%)
shoulder arthroplasties with a haematocrit above this level. . Discussion . We found that transfusion was needed less frequently than previously
described for shoulder arthroplasty. Patients with a pre-operative
haematocrit <
39.6% should be advised that there is an increased
risk for
The purpose of the present study was to evaluate the impact of
intravenous tranexamic acid on the reduction of blood loss, transfusion
rate, and early post-operative clinical outcome in total shoulder
arthroplasty. A randomised, placebo-controlled trial which included 54 patients
undergoing unilateral primary stemless anatomical or stemmed reverse
total shoulder arthroplasty was undertaken. Patients received either
100 ml saline (placebo, n = 27), or 100 ml saline together with
1000 mg of tranexamic acid (TXA, n = 27) intravenously prior to
skin incision and during wound closure. Peri-operative blood loss
via an intra-articular drain was recorded and total blood loss was
calculated. The post-operative transfusion rate was documented.
Assessment of early clinical parameters included the visual analogue
scale for pain (VAS), documentation of haematoma formation and adverse events.Aims
Patients and Methods
Depression can significantly affect quality of life and is associated
with higher rates of medical comorbidities and increased mortality
following surgery. Although depression has been linked to poorer
outcomes following orthopaedic trauma, total joint arthroplasty
and spinal surgery, we wished to examine the impact of depression
in elective total shoulder arthroplasty (TSA) as this has not been
previously explored. The United States Nationwide Inpatient Sample (NIS) was used
to identify patients undergoing elective TSA over a ten-year period.
Between 2002 and 2012, 224 060 patients underwent elective TSA.Aims
Patients and Methods
The aim of the present study was to compare the 30- and 90-day
re-admission rates and complication rates of outpatient and inpatient
total shoulder arthroplasty (TSA). The United States Medicare Standard Analytical Files database
was questioned to identify patients who had undergone outpatient
or inpatient TSA between 2005 and 2012. Patient characteristics
were compared between the two groups using chi-squared analysis. Multivariate
logistic regression analysis was used to control for differences
in baseline patient characteristics and to compare the two groups
in terms of post-operative complications within 90 days and re-admission
within 30 days and 90 days.Aims
Patients and Methods
