Background and aims We aimed to analyze factors influencing postoperative complications and mortality for patients undergoing THA and TKA.

Methods Patients from Notre Dame des Secours University Hospital-Jbeil, Lebanon, who underwent THA and TKA between 2012 and 2017, were matched by year, age, sex, smoking, diabetes, cardiac, pulmonary and renal pathologies. We analyzed the anesthesia technique, hematocrit and hemoglobin levels preoperatively and postoperatively, transfusion requirements, length of stay in the ICU and the hospital, complications and mortality.

Results We identified 501 patients: 245 patients underwent THA (48.9%) and 256 underwent TKA (51.1%); mean age was 69 years old, with 349 (69.7%) woman and 152 (30.3%) man. 136 (27, 1%) patients were done under general anesthesia and 365 (72.9%) under regional technique. 170 (33.9%) patients needed transfusion mainly postoperatively. We found that the type of the surgery, sex, anesthesia technique, smoking, diabetes, cardiac, pulmonary and renal pathologies do not affect the morbi-mortality. We had a correlation between preoperative anemia and the incidence of pulmonary edema, between preoperative transfusion and pulmonary edema, postoperative death and acute coronary syndrome (ACS). Postoperative anemia is related to ACS and postoperative transfusion to pulmonary edema, which is associated with a prolonged length of stay in the ICU and hospital and to death. There is a relation between age and pulmonary edema, respiratory complications and mortality.

Conclusions This study confirms the higher risk of elderly patients anemic and transfused preoperatively or postoperatively after joint arthroplasty. Implementing strategies that prevent transfusion could be with good benefits.