Perioperative blood transfusion and adverse events in total hip and knee arthroplasty: a TriNetX-based analysis

Background Life expectancy has increased globally, leading to a higher prevalence of age-related and metabolic diseases and, consequently, a rising incidence of osteoarthritis among older adults. Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are well-established surgical treatments for advanced osteoarthritis. Despite advances in perioperative management, blood loss remains a major concern and often necessitates allogeneic blood transfusion. This study used the TriNetX global research database to investigate the association between perioperative allogeneic blood transfusion and adverse postoperative outcomes. Methods This retrospective cohort study analyzed de-identified data from the TriNetX network, a global clinical research platform. Patients who underwent TKA or THA between January 2019 and September 2024 were included. Exclusion criteria were age younger than 18 years and documented infections within 3 days prior to surgery. A total of 323,669 cases were identified. Patients were categorized into perioperative transfusion and non-transfusion groups, and propensity score matching was performed at a 1:1 ratio, yielding 2,040 matched pairs. Primary outcomes included postoperative transfusion, infection-related complications, thromboembolic events, and 30-day mortality. Statistical analyses were conducted using chi-square tests, t -tests, and Cox proportional-hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results The incidence of perioperative allogeneic blood transfusion was 0.63% ( n = 2,041). Perioperative blood transfusion was associated with a significantly increased risk of adverse outcomes within 30 days after total joint replacement, including postoperative transfusion (HR = 9.67, p 0.001), procedural infections (HR = 3.82, p 0.001), sepsis (HR = 2.30, p = 0.001), deep vein thrombosis (HR = 2.20, p = 0.002), and 30-day mortality (HR = 2.90, p = 0.002). Conclusion Perioperative allogeneic blood transfusion in patients undergoing TKA or THA is associated with an increased risk of postoperative transfusion, infectious complications, thromboembolic events, and mortality. These findings underscore the importance of implementing patient blood management and blood conservation strategies to mitigate transfusion-related complications.