Transfusion Mortality and Morbidity in Orthopedic Surgery

SUMMARY Red blood cell transfusions are commonly used in orthopedic surgery and cost billions of dollars annually. The goals of transfusion are to reduce mortality, morbidity and functional impairment that result from anemia and inadequate oxygen delivery. Risks of infections from transfusion are low and continue to decline, but evidence is growing that red cell transfusions are immunosuppressive and predispose patients to postoperative infections. However, there actually are very little data on when transfusion is indicated. Observational data suggest that transfusion does not reduce mortality in patients with pre- or postoperative hemoglobin levels >8 g/dL, although no conclusions could be drawn about the effect of transfusion in patients with hemoglobin >8 g/dL. Large well-performed randomized clinical trials are needed to establish the efficacy of transfusion. Until better data are available, orthopedic surgeons will have to rely on clinical judgement in transfusion decisions. The author recommends using a higher transfusion threshold in patients with cardiovascular disease.