Perioperative blood transfusion requirements and predictive factors in total hip replacement: A retrospective study from Eastern India

Abstract: BACKGROUND: Total hip replacement (THR) is frequently associated with significant blood loss, often necessitating transfusions. Judicious transfusion practices are essential, especially in resource-limited settings. This study aimed to evaluate transfusion requirements and identify the perioperative predictors of transfusion in patients undergoing THR. MATERIALS AND METHODS: A retrospective observational study was conducted at a tertiary care center in Eastern India from January 2022 to December 2024. Data from 102 adult patients undergoing elective primary or revision THR were analyzed. Demographic, clinical, surgical, and transfusion-related parameters were compared between transfused and nontransfused groups. Statistical significance was set at P < 0.05. RESULTS: Of the 102 patients, 70.6% required red blood cell (RBC) transfusion. Transfused patients had significantly lower baseline hemoglobin (Hb; 9.13 ± 1.51 vs. 10.47 ± 1.59 g/dL, P < 0.001), greater intraoperative and postoperative blood loss, longer hospital stays, and higher American Society of Anesthesiologists physical status classification scores. General anesthesia use and presence of comorbidities were significantly associated with transfusion need, whereas spinal anesthesia and tranexamic acid (TXA) use were protective factors. A total of 225 blood components were used, primarily RBCs. CONCLUSION: A high transfusion rate was observed in THR patients, predominantly influenced by preoperative anemia, blood loss, comorbidities, and anesthesia type. TXA use and spinal anesthesia significantly reduced transfusion need. Optimizing Hb levels preoperatively, standardizing TXA use, and preferring spinal anesthesia could enhance blood conservation. These findings support the need for targeted blood management protocols in orthopedic surgeries in resource-limited settings.