Hemodynamics, fluids & transfusion
Bleeding Complications, Transfusion, and Acute Care Costs After Major Arthroplasty in Patients With Hereditary Bleeding Disorders: A National Healthcare Database Analysis
Authors' conclusion
THA and TKA in patients with hereditary BDs are relatively safe, with most outcomes comparable to controls.
Study context
- Population
- Patients undergoing elective TKA and THA, Premier Health Database (2017–2021)
- Participants
- 1,528 vs 20,509
- Exposure
- BD vs Controls
- BDn = 1,528
- Controlsn = 20,509reference
- Outcome
- Perioperative bleeding complications (hemorrhage/hematoma, allogeneic transfusions, postoperative anemia)
Methodological detailsnational healthcare database
- National healthcare database
Main finding
As reported in the abstract
Bleeding complications (hemorrhage and hematoma)
P < 0.0001
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Transfusion, THA | 2.7 (2.0–3.7) | P < 0.0001 | |
| Transfusion, TKA | 2.6 (1.9–3.8) | P < 0.0001 | |
| 0.20.5125Odds ratio (log scale) |
Clotting factor concentrate (CFC) exposure
Mean $
| Outcome | BD | Controls |
|---|---|---|
| Pharmacy costs | 23,792 (95% CI $8722-$39,312) | 750 (95% CI $739-$762) |
- Clotting factor concentrate (CFC) exposure — Of 270 CFC exposures: Factor VIII (FVIII)
- 49.6%
- Clotting factor concentrate (CFC) exposure — von Willebrand factor (VWF)
- 23.0%
- Clotting factor concentrate (CFC) exposure — FIX concentrate
- 12.6%
- Clotting factor concentrate (CFC) exposure — FVIIa
- 8.5%
- Clotting factor concentrate (CFC) exposure — Anti-inhibitor coagulant complex (AICC)
- 3.7%
Clotting factor concentrate (CFC) exposure
- Antifibrinolytic therapy administered in most cases
Pharmacy costs
- Over 30 times the mean cost in controls
Other outcomes
- Not different between groups, except VTE
Safety
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| VTE | 3.9 (2.4–6.1) | P < 0.0001 | |
| 0.10.31310Odds ratio (log scale) |
Original publication
Bleeding Complications, Transfusion, and Acute Care Costs After Major Arthroplasty in Patients With Hereditary Bleeding Disorders: A National Healthcare Database Analysis. Anesth Analg. Published 4 April 2025. doi:10.
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