The effect of surgeon volume on the need for transfusion following primary unilateral hip and knee arthroplasty

Introduction: we reviewed transfusion practice following primary hip and knee arthroplasty with emphasis on the relationship between surgeon volume and the need for transfusion.

Materials/methods: review of a consecutive series of 508 primary, elective, unilateral arthroplasties (248 THR/260 TKR) performed over a 12-month period. Data were analysed to determine the overall rate of transfusion and the details of any such transfusion. Secondarily, multivariate regression was performed to determine the effects of surgeon volume and other recorded variables upon the need for transfusion. For the purpose of analysis we classified surgeons doing more than 52 arthroplasties a year as "high volume" and surgeons performing less than this number as "low volume".

Results: transfusion rates were 10% and 7% following THR and TKR. Multivariate analysis demonstrated that surgeon volume (<52 operations/yr vs. >52 operations/yr) and preoperative Hb<12g/dl were the only significant determinants of a need for postoperative transfusion (p<0.01). High volume and low volume surgeons transfused 5% vs. 17%, respectively (RR=3.3 (95%CI 1.5-9.1) p=0.003) following THR and 4% vs. 13% (RR=3.6 (95%CI 1.4-9.3) p=0.006) following TKR.

Discussion and conclusion: High volume surgeons have significantly lower transfusion rates when compared to nationally accepted figures.