{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T19:52:45Z","timestamp":1794513165843,"version":"4.9.1"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Hochschule Brandenburg CAMPUS GmbH"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Perioperative blood transfusion remains a relevant concern in elective total hip arthroplasty (THA), as it is associated with adverse outcomes and increased healthcare utilization. Reliable, procedure-specific risk stratification tools based on routinely available clinical data are needed to support individualized perioperative blood management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included consecutive patients undergoing elective primary THA between 2016 and 2023 at a single certified arthroplasty center. Demographic data, comorbidity burden (ASA classification), perioperative laboratory values, operative characteristics, blood loss parameters, and transfusion data were extracted from a prospectively maintained registry. The primary outcome was perioperative allogeneic red blood cell transfusion. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of transfusion. Model performance was assessed using receiver operating characteristic analysis and calibration testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 648 patients were included, of whom 104 (16.0%) required perioperative transfusion. Transfused patients demonstrated lower preoperative hemoglobin levels, greater perioperative hemoglobin decline, and higher total and hidden blood loss. On multivariable analysis, lower preoperative hemoglobin, longer operative time, greater intraoperative blood loss, and lower body mass index were independently associated with transfusion, while male sex was inversely associated. Higher comorbidity burden (ASA\u2009\u2265\u2009III) showed a borderline association after adjustment. The final model demonstrated excellent discrimination with an area under the curve of 0.878 and good calibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>External validation of the present model is required before routine clinical application. Perioperative transfusion following elective primary THA can be predicted with good discriminative performance using routinely available clinical variables, supporting perioperative risk assessment and individualized blood management, although its applicability for preoperative patient counseling is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level III (retrospective cohort study).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12891-026-09979-4","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T01:38:29Z","timestamp":1780969109000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A multivariable model for perioperative transfusion risk in elective primary THA"],"prefix":"10.1186","volume":"27","author":[{"given":"Nikolai","family":"Ramadanov","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Voss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Heinz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dakota","family":"Fuchs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Prill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Becker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"9979_CR1","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s12891-019-2411-9","volume":"20","author":"IN Ackerman","year":"2019","unstructured":"Ackerman IN, Bohensky MA, Zomer E, et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord. 2019;20:90. https:\/\/doi.org\/10.1186\/s12891-019-2411-9.","journal-title":"BMC Musculoskelet Disord"},{"key":"9979_CR2","doi-asserted-by":"publisher","unstructured":"Maradit Kremers H, Larson DR, Crowson CS et al. Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am. 2015;97:1386\u201397. https:\/\/doi.org\/10.2106\/JBJS.N.01141.","DOI":"10.2106\/JBJS.N.01141"},{"key":"9979_CR3","doi-asserted-by":"publisher","first-page":"20","DOI":"10.2106\/JBJS.M.00018","volume":"96","author":"PJ Belmont","year":"2014","unstructured":"Belmont PJ, Goodman GP, Waterman BR, et al. Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am. 2014;96:20\u20136. https:\/\/doi.org\/10.2106\/JBJS.M.00018.","journal-title":"J Bone Joint Surg Am"},{"key":"9979_CR4","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1186\/s12891-025-08801-x","volume":"26","author":"C Peng","year":"2025","unstructured":"Peng C, Qiao L. Risk factors for perioperative blood transfusion in total hip arthroplasty: a meta-analysis. BMC Musculoskelet Disord. 2025;26:569. https:\/\/doi.org\/10.1186\/s12891-025-08801-x.","journal-title":"BMC Musculoskelet Disord"},{"key":"9979_CR5","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1302\/0301-620X.86B4.14508","volume":"86\u2013B","author":"KR Sehat","year":"2004","unstructured":"Sehat KR, Evans RL, Newman JH, MANAGEMENT OF BLOOD LOSS SHOULD TAKE HIDDEN LOSS INTO ACCOUNT. Hidden blood loss following hip and knee arthroplasty: CORRECT. J Bone Joint Surg Br Volume. 2004;86\u2013B:561\u20135. https:\/\/doi.org\/10.1302\/0301-620X.86B4.14508.","journal-title":"J Bone Joint Surg Br Volume"},{"key":"9979_CR6","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1111\/j.1423-0410.2010.01428.x","volume":"100","author":"\u00d8 Jans","year":"2011","unstructured":"Jans \u00d8, Kehlet H, Hussain Z, et al. Transfusion practice in hip arthroplasty \u2013 a nationwide study. Vox Sang. 2011;100:374\u201380. https:\/\/doi.org\/10.1111\/j.1423-0410.2010.01428.x.","journal-title":"Vox Sang"},{"issue":"2","key":"9979_CR7","doi-asserted-by":"publisher","first-page":"87","DOI":"10.22038\/ABJS.2024.80590.3681","volume":"13","author":"M Boutros","year":"2025","unstructured":"Boutros M, Nham FH, Corsi MP, Aoun M, Lopez J, Kassis E, Daher M, El-Othmani MM. Bibliometric Analysis of Outpatient Hip and Knee Arthroplasty Research Evolution. Arch Bone Jt Surg. 2025;13(2):87\u201399. https:\/\/doi.org\/10.22038\/ABJS.2024.80590.3681.","journal-title":"Arch Bone Jt Surg"},{"issue":"1","key":"9979_CR8","doi-asserted-by":"publisher","first-page":"2610097","DOI":"10.1080\/07853890.2025.2610097","volume":"58","author":"X Liu","year":"2026","unstructured":"Liu X, Liu M, Yang Y, Yue C, Tang Y, Xie D, Gao Q, Wu X, Guo J. Risk prediction models for blood transfusion in patients undergoing total hip and knee arthroplasty: a systematic review and meta-analysis. Ann Med. 2026;58(1):2610097. https:\/\/doi.org\/10.1080\/07853890.2025.2610097.","journal-title":"Ann Med"},{"key":"9979_CR9","doi-asserted-by":"publisher","DOI":"10.1186\/s40001-026-04070-z","author":"N Ramadanov","year":"2026","unstructured":"Ramadanov N, Voss M, Heinz M, Prill R, Fuchs D, Becker R. Short vs standard stems perioperative blood loss and complication risk. Eur J Med Res. 2026. https:\/\/doi.org\/10.1186\/s40001-026-04070-z.","journal-title":"Eur J Med Res"},{"issue":"3","key":"9979_CR10","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1111\/os.70270","volume":"18","author":"N Ramadanov","year":"2026","unstructured":"Ramadanov N, Fuchs D, Heinz M, Prill R, Becker R. Perioperative Factors Associated With Allogeneic Blood Transfusion in Elective THA. Orthop Surg. 2026;18(3):576\u201386. . https:\/\/doi.org\/10.1111\/os.70270","journal-title":"Orthop Surg"},{"key":"9979_CR11","doi-asserted-by":"publisher","unstructured":"Ramadanov N, Fuchs D, Heinz M, Prill R, Becker R. Cemented versus uncemented stems in total hiparthroplasty: No independent effect on transfusion or complications despite reduced total blood loss. J Exp Orthop. 2026;13:e70734. https:\/\/doi.org\/10.1002\/jeo2.70734.","DOI":"10.1002\/jeo2.70734."},{"key":"9979_CR12","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1002\/bjs.1800239202","volume":"23","author":"R Watson-Jones","year":"1936","unstructured":"Watson-Jones R. Fractures of the neck of the femur. Br J Surg. 1936;23:787\u2013808. https:\/\/doi.org\/10.1002\/bjs.1800239202.","journal-title":"Br J Surg"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12891-026-09979-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-026-09979-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-026-09979-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T02:54:32Z","timestamp":1780973672000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12891-026-09979-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["9979"],"URL":"https:\/\/doi.org\/10.1186\/s12891-026-09979-4","relation":{},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]},"assertion":[{"value":"27 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Ethics Committee of the Brandenburg Medical School Theodor Fontane (approval number: 292032025-BO-E-RETRO). The requirement for informed consent was formally waived by the same committee due to the retrospective design and anonymized data processing. All procedures were performed in accordance with relevant guidelines and regulations and with the principles of the Declaration of Helsinki (latest revision). The requirement for informed consent was waived due to the retrospective design of the study and the use of anonymized data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"502"}}