Minimizing blood transfusions in total shoulder arthroplasty

Over the past decade and a half the incidence of total shoulder arthroplasty (TSA) has increased by as much as 9.4% annually (1) and in 2011, an estimated 66,485 were performed (2). TSA is a major surgery, with the risk of significant blood loss. Complications associated with allogeneic blood transfusion have been well established and include immunologic reaction, infection, cardiopulmonary complications and death. A recent study demonstrated a significantly higher risk of postoperative wound and respiratory infections in those who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) and received postoperative blood transfusions (3). Furthermore, allogeneic blood transfusion is costly. If all hospital expenditures are considered, total costs may exceed $1,000 for each unit of blood transfused (4).