Preoperative Hemoglobin as a Predictor of Transfusion Requirement in Patients Undergoing Elective Hip Arthroplasty

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Introduction Preoperative anemia is one of the main factors associated with transfusion requirements in major orthopedic surgery. Early identification of patients at higher transfusion risk enables the implementation of Patient Blood Management (PBM) strategies aimed at preoperative optimization and the rational use of blood components. However, national data on the predictive ability of preoperative hemoglobin for transfusion requirements in elective hip arthroplasty remain limited. Objectives To evaluate the predictive performance of preoperative hemoglobin for transfusion requirements in patients undergoing elective hip arthroplasty. Materials and methods This retrospective observational study was conducted at Fundação Hospital Adriano Jorge (FHAJ), a tertiary referral hospital in the Brazilian Amazon region, including patients who underwent elective hip arthroplasty between 2024 and 2025. A total of 129 patients were identified, of whom 73 with available preoperative hemoglobin records were included in the analysis. Hemoglobin distribution was assessed using the Shapiro–Wilk test. Mean values were compared using Student’s t-test. The association between preoperative hemoglobin and transfusion requirement was analyzed using binary logistic regression, and predictive performance was evaluated by receiver operating characteristic (ROC) curve analysis. Statistical analyses were performed using Python software version 3.12.5, adopting a significance level of 5%. Results Patients who required transfusion had significantly lower mean preoperative hemoglobin levels than those who did not receive transfusion (11.50 ± 2.33 vs. 13.46 ± 1.62 g/dL; mean difference, 1.96 g/dL; 95% CI, 0.94–2.99; p = 0.0003). In the logistic regression, each 1 g/dL increase in preoperative hemoglobin was associated with an approximately 44% reduction in the odds of transfusion (OR = 0.56; 95% CI, 0.40–0.80; p = 0.001). Preoperative hemoglobin demonstrated moderate discriminatory ability for predicting transfusion requirement (AUC = 0.77; 95% CI, 0.59–0.92; p = 0.0004), with a cutoff of ≤10.9 g/dL (sensitivity, 60.0%; specificity, 93.1%). Discussion and conclusion The results demonstrate that lower preoperative hemoglobin levels were associated with transfusion requirements, highlighting their potential as a preoperative risk marker in patients undergoing elective hip arthroplasty. The observed discriminatory ability, together with the identified cutoff, may assist in transfusion risk stratification and in guiding PBM strategies. Therefore, incorporating preoperative hemoglobin into the preoperative assessment may contribute to transfusion support planning and to the implementation of PBM strategies in patients undergoing elective hip arthroplasty.