The Association Between Preoperative Hemoglobin Values And Hospitalization Outcomes Following Elective Primary Total Joint Replacement

In the current era of bundled payments, greater focus has been placed on preoperative patient optimization. This study examined the prevalence of preoperative anemia from 2007-2017 among patients undergoing elective total joint arthroplasty (TJA) and its association with transfusion. This retrospective analysis used healthcare claims data from the Optum ClinformaticsTM Data Mart database (2007-2017). Patient selection criteria included: hospitalization for elective TJA, age ≥18, and no diagnosis of a hematologic disorder. Patients were required to have at least one (90 days prior to admission) laboratory value for hemoglobin (Hgb); the most recent Hgb value was used to define anemia using the World Health Organization criteria. Logistic regression controlling for age, Charlson Score, region, payor, and procedure type evaluated the association between preoperative anemia and risk of transfusion. 44,989 patients met selection criteria; mean age was 64 years and 59% were female. Overall, 85.7% of patients were preoperatively classified as non-anemic, 11.0% were anemic, and 3.3% severely anemic. Anemia category did not change over time, with 13% of patients categorized as anemic or severely anemic from 2007 to 2017. Incidence of transfusion increased from 7.1% (no anemia) to 19.9% (anemia) and 33.2% (severe anemia; P