Postoperative venous thromboembolism (VTE) is a serious complication of orthopedic surgery, with significant morbidity and death. Knowing a patient’s VTE risk can aid in selecting perioperative VTE prophylaxis. Red blood cells (RBCs) have recently been linked to the development of pathologic thrombosis. As a result, researchers investigated the link between perioperative RBC transfusion and postoperative VTE in patients undergoing orthopedic surgery.

A secondary examination of data from the 2016 American College of Surgeons National Surgical Quality Improvement Program database was used to conduct a retrospective cohort study. A total of 234,608 people received orthopedic surgery in the study. Patients were exposed to whether or not they got a perioperative RBC transfusion. The primary outcome was postoperative VTE that required therapeutic intervention within 30 days of surgery, further divided into symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE). A multivariate logistic regression model was used to calculate odds ratios (ORs).

At the start of the study, 1,952 patients (0.83%) experienced postoperative VTE (DVT in 1,299 [0.55%], PE in 801 [0.34%], and both DVT and PE in 148 [0.06%]). Preoperative RBC transfusions were given to 795 patients (0.3%), postoperative RBC transfusions were given to 11,587 patients (4.9%), and both preoperative and postoperative RBC transfusions were given to 848 patients (0.4%). Independent of other presumed risk factors, postoperative RBC transfusion was associated with an increased risk of VTE (aOR, 1.47; 95% CI, 1.19-1.81), DVT (aOR, 1.40; 95% CI, 1.09-1.79), PE (aOR, 1.59; 95% CI, 1.14-2.22), and 30-day mortality (aOR, 1.21; 95% CI, 1.01-1.45). Postoperative transfusions in spine (aOR, 2.03; 95% CI, 1.13-3.67) and trauma (aOR, 1.40; 95% CI, 1.06-1.86) were linked with greater risks of postoperative VTE when subgroups within orthopaedics were created using Current Procedural Terminology codes.

Independent of covariates, the findings implied that postoperative RBC transfusion might be linked with an elevated risk of postoperative VTE, including symptomatic DVT and life-threatening PE. To corroborate the findings, more prospective validation in cohort studies was required. 

Reference:journals.lww.com/jaaos/Abstract/2022/07010/Red_Blood_Cell_Transfusions_and_Risk_of.12.aspx