Independent preoperative predictors of day-of-surgery red cell transfusion in major orthopedic surgery: a six-year retrospective cohort of 7072 patients

BACKGROUND: Major Orthopedic Surgery (MOS) is frequently associated with significant blood loss, potentially resulting in perioperative anemia and the need for allogeneic blood transfusion, which carries inherent risks. This study aimed to identify independent preoperative predictors of early Packed Red Blood Cell (PRBC) transfusion in patients undergoing MOS. METHODS: ), administration of tranexamic acid, and the requirement for PRBC transfusion. RESULTS: (Relative Risk [RR] 6.55), high-risk surgical procedures (RR = 7.40), ASA physical status III‒IV (RR = 2.00), absence of tranexamic acid use (RR = 2.52), and, to a lesser extent, age > 75 years (RR = 1.50). The combination of all identified risk factors was associated with a markedly increased transfusion risk (RR = 14.55; p < 0.0001). CONCLUSION: These findings have informed modifications to our clinical practice, aimed at enhancing quality standards through the implementation of more effective Patient Blood Management (PBM) strategies.