Preoperative predictors for allogeneic blood transfusion in oncological patients undergoing total knee arthroplasty

Background. The goal of study is to identify factors predicting the need for intra-operative allogeneic blood transfusion in oncological patients undergoing unilateral total knee replacement.
Methods. From 2006 to 2013, 290 patients undergoing primary and 87 revision total knee arthroplasty were enrolled in the retrospective study. Transfused allogeneic red blood cells, allogeneic fresh frozen plasma was calculated. Risk factors were age, weight, height, sex, body mass index, pre-operative hemoglobin level, tumor morphology, pre-operative chemotherapy, pathologic fracture, tranexamic acid using, tourniquet, surgeon, type of anesthesia.
Results. The frequency of allogeneic blood transfusion varied with respect to the type of operative procedure: primary 37% (106/290) versus revision 20% (17/87) total knee arthroplasty (р=0,003; odds ratio, 2,4 [95% confidence interval, 1,33 to 4,24]). Ordered logistic regression analysis showed the most important predictors of the transfusion of allogeneic blood components during primary surgery to be a pre-operative hemoglobin level, weight, lack of use of tranexamic acid, pathologic fracture; during revision surgery: pre-operative hemoglobin level and less skilled surgeon.
Conclusions. For decreasing allogeneic blood transfusion during total knee replacement it is required to increase pre-operative hemoglobin level, to use tranexamic acid and to improve operational skills.