Operative Time Directly Correlates with Blood Loss and Need for Blood Transfusion in Total Joint Arthroplasty

Background: Allogeneic blood transfusion in patients undergoing total joint arthroplasty (TJA) has been shown to negatively affect patient outcomes. This study aimed to examine if there is a correlation between operative time and the need for allogeneic blood transfusions during TJA. Methods: We performed a retrospective review of 866 patients who underwent primary TJA during a one-year period at our institution. Logistic regression was performed to identify the association between operative time and need for allogeneic blood transfusion, controlling for other patient and surgical factors. Multiple linear regression analysis was also performed to see how the same factors affected CBL. Results: Of the 866 cases, 13%(115) were simultaneous bilateral. 52%(449) of patients received preoperative autologous blood donation. The average operative time for unilateral and bilateral patients was 74.1±(33.9) and 132.6±(36.0) minutes, respectively. Average CBL for unilateral patients was 2120mL±(1208) and 4051mL±(1311) for bilateral cases. The average number of allogeneic transfusions was also higher within the bilateral group (0.49 vs 1.15 units). Multivariate analysis indicated that duration of surgery (odds ratio [OR]:1.35 per 15 minutes) and bilateral TJA (OR: 2.97) increase the risk of allogeneic blood transfusion, while patients having total knee arthroplasty are less likely to receive allogeneic blood transfusion (OR: 0.50). CBL also increased significantly with surgical duration (211.5 mL per 15 minutes). Conclusion: A subgroup analysis confirmed that there was a correlation between operative time and need for allogeneic transfusion following unilateral TJA. Expeditious surgery can minimize blood loss and subsequent need for blood transfusion and its associated adverse consequences. Keywords