The true cost of a blood transfusion

Incidence of blood transfusions in knee replacement surgery has both direct and indirect costs to the hospital. A recent large-scale analysis of over 4 million TKA cases from 2000-20091 identified numerous negative results in terms of cost and outcomes for patients, including:

  • The overall blood transfusion rate for TKA cases was 12.1%, with the rate increasing about 5% between 2000 and 2009
  • Transfused patients had a higher incidence of co-morbidities, including deficiency anemia, renal failure, chronic blood loss, and coagulopathy
  • Transfused patients had a 0.68 days longer length of stay
  • Hospital admission costs increased by $2,237 for transfused patients
  • The risk of additional post-operative complications, including infection, also increased in transfused patients

This study very clearly demonstrated both negative patient outcomes as well as financial burden when blood transfusions are involved in a procedure.

Is it possible to reduce blood transfusions to zero?

An analysis of 89 first-generation iTotal patients (106 knees), including 15 simultaneous bilateral replacements, across four centers saw zero cases requiring blood transfusions.2

In another study comparing one surgeon’s iTotal cases with a standard off-the-shelf TKA, zero of 54 patients (66 knees) required blood transfusions. Four patients from the off-the-shelf arm (60 patients, 66 knees) required transfusions. (Figure 1) 3

The differences in blood loss seen using a patient-specific implant and an off-the-shelf implant could be partially explained by the lack of femoral canal penetration and the ability to completely cover all cut bone surfaces with a patient-specific implant.


1: Szubski, et al; National Trends in Utilization and Outcomes of Allogenic Blood Transfusion in Primary Total Knee Arthroplasty, 2000-2009. ISTA Annual Meeting 2013, Poster #2451

2: Kurtz, et al; Early Outcomes Utilizing a First-Generation Customized Patient-Specific TKA Implant. BASK Annual Meeting 2014, Poster #0185

3: Kurtz, William; Patient-Specific Knee Replacement Implants Preserve Bone and Decrease Blood Loss & Swelling. BASK Annual Meeting 2013, Poster #0138

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