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Xie J, Feng X, Ma J, Kang P, Shen B, Yang J, Zhou Z, Pei F. Is postoperative cell salvage necessary in total hip or knee replacement? A meta-analysis of randomized controlled trials. Int J Surg 2015; 21:135-44. [PMID: 26253852 DOI: 10.1016/j.ijsu.2015.07.700] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/15/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether there are hematological or clinical differences with the use of postoperative cell salvage after total knee (TKR) and hip replacement (THR). METHODS A systematic literature review based on PubMed, EMBASE, the Cochrane Library Database in any language regarding postoperative cell salvage following TKR or THR was performed. High quality of randomized controlled trials were identified. The data was analyzed using Rev Man 5.2. RESULTS 19 randomized controlled trials (12 in TKR, 4 in THR and 3 in both) about 3482 patients were identified and included in this meta-analysis. Postoperative cell salvage significantly reduced the allogeneic blood transfusion requirement after TKR (RR = 0.46, 95% CI = 0.30 to 0.72) and THR (RR = 0.46, 95%CI = 0.32 to 0.68). It also demonstrated a higher level of postoperative Hemoglobin (MD = 0.26 g/dL, 95%CI = 0.15 to 0.37) with the use of postoperative cell salvage. No significant differences were detected regarding length of hospital stay, the incidence of febrile reaction, wound infection and deep vein thrombosis. CONCLUSION The results strengthen the fact that postoperative cell salvage is effective and safe to reduce the rate of transfusion after TKR and THR. As the relatively poor methodological quality and heterogeneity, further research is needed to confirm its safety and cost-effectiveness.
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Affiliation(s)
- Jinwei Xie
- Department of Orthopaedic Surgery and Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China
| | - Xiaowei Feng
- Department of Orthopaedic Surgery and Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China
| | - Jun Ma
- Department of Orthopaedic Surgery and Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China
| | - Pengde Kang
- Department of Orthopaedic Surgery and Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China
| | - Bin Shen
- Department of Orthopaedic Surgery and Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China
| | - Jing Yang
- Department of Orthopaedic Surgery and Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China
| | - Zongke Zhou
- Department of Orthopaedic Surgery and Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China
| | - Fuxing Pei
- Department of Orthopaedic Surgery and Dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China.
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Benjamin JB, Colgan KM. Are Routine Blood Salvage/Preservation Measures Justified in All Patients Undergoing Primary TKA and THA? J Arthroplasty 2015; 30:955-8. [PMID: 25662674 DOI: 10.1016/j.arth.2015.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/12/2015] [Accepted: 01/16/2015] [Indexed: 02/01/2023] Open
Abstract
A sequential series of 366 primary total knee arthroplasties and 320 total hip arthroplasties was reviewed to determine the incidence of allogeneic transfusion. Surgery was performed under regional anesthesia and all patients had a hemovac drain for 24°. Tourniquet hemostasis in TKA was maintained through wound closure. Coumadin, SCD and TED hose were utilized for DVT prophylaxis. No additional blood conservation measures were employed. The transfusion incidence in primary TKA was 2.2% (males .6%/females 3.5%). The transfusion incidence in THA was 1.9%, (males .8%/females 2.6%). The low incidence of allogeneic transfusion in a contemporary series of primary TKA and THA, especially in males, would question the need for routine blood preservation techniques in this group of patients.
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Styron JF, Higuera CA, Klika AK, Molloy R. The role of tranexamic acid in a comprehensive blood management protocol for total hip and knee arthroplasty patients. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.sart.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Blood transfusion in primary total shoulder arthroplasty: incidence, trends, and risk factors in the United States from 2000 to 2009. J Shoulder Elbow Surg 2015; 24:760-5. [PMID: 25672258 DOI: 10.1016/j.jse.2014.12.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/21/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) may be associated with substantial blood loss, and some patients require perioperative blood transfusion. Possible blood transfusion methods include predonated autologous blood transfusion, perioperative autologous blood transfusion, and allogeneic blood transfusion (ALBT). The purposes of the present study were to assess the incidence and recent trends over time of blood transfusion in TSA and analyze patient and hospital characteristics that affect the risk of ALBT. METHODS This study used national hospital discharge data from the National Inpatient Sample between 2000 and 2009. The data were used to generate the overall blood transfusion rate, and linear regression was used to assess trends in transfusion patterns over time. Logistic regression analysis was performed to analyze which patient and hospital characteristics independently influence the likelihood that a given patient undergoes ALBT. RESULTS The overall blood transfusion rate (ie, the proportion of patients who received at least 1 transfusion of any kind) was 6.7%. This rate increased over time, from 4.9% in 2000 to 7.1% in 2009 (P < .001). Risk factors associated with ALBT included age, gender, race, insurance status, hospital region, and hospital annual caseload. CONCLUSIONS The increase in overall blood transfusion rate in TSA found in the present study may be related to factors specific to TSA, such as the introduction of reverse total shoulder arthroplasty during the study period. A variety of patient and hospital characteristics contribute to the risk of undergoing ALBT.
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Stoicea N, Bergese SD, Ackermann W, Moran KR, Hamilton C, Joseph N, Steiner N, Barnett CJ, Smith S, Ellis TJ. Current status of blood transfusion and antifibrinolytic therapy in orthopedic surgeries. Front Surg 2015; 2:3. [PMID: 25729751 PMCID: PMC4325662 DOI: 10.3389/fsurg.2015.00003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/22/2015] [Indexed: 01/28/2023] Open
Affiliation(s)
- Nicoleta Stoicea
- Department of Anesthesiology, Wexner Medical Center, Ohio State University , Columbus, OH , USA
| | - Sergio D Bergese
- Department of Anesthesiology, Wexner Medical Center, Ohio State University , Columbus, OH , USA ; Department of Neurological Surgery, Wexner Medical Center, Ohio State University , Columbus, OH , USA
| | - Wiebke Ackermann
- Department of Anesthesiology, Wexner Medical Center, Ohio State University , Columbus, OH , USA
| | - Kenneth R Moran
- Department of Anesthesiology, Wexner Medical Center, Ohio State University , Columbus, OH , USA
| | - Charles Hamilton
- Department of Anesthesiology, Wexner Medical Center, Ohio State University , Columbus, OH , USA
| | - Nicholas Joseph
- Department of Neuroscience, Ohio State University , Columbus, OH , USA
| | - Nathan Steiner
- Drexel University College of Medicine , Philadelphia, PA , USA
| | | | - Stewart Smith
- College of Medicine, Wexner Medical Center, Ohio State University , Columbus, OH , USA
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Gofton W, Chow J, Olsen KD, Fitch DA. Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique. INTERNATIONAL ORTHOPAEDICS 2014; 39:847-51. [PMID: 25398472 DOI: 10.1007/s00264-014-2587-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 10/27/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Recent studies have reported nearly 40% of costs associated with a 30-day episode-of-care for total joint replacements are due to post-discharge activities and 81% of those are specifically due to unplanned readmissions and discharging patients to post-acute care facilities. The purpose of this study was to determine these two key variables for total hip arthroplasty (THA) patients implanted using a tissue-sparing surgical technique and to see how these values compare to those previously reported in the United States. METHODS The healthcare databases at three institutions were searched for primary THA patients implanted using the supercapsular percutaneously-assisted total hip (SuperPath) surgical technique between January 2013 and July 2014. Data elements included 30-day all-cause readmission rate, discharge status, transfusion rate, complications, and length of stay (LOS). RESULTS Data were available for 479 THAs. The 30-day all-cause readmission rate, transfusion rate, and average LOS was 2.3, 3.3%, and 1.6 days, respectively. Over 91% of patients were discharged routinely home, 4.1% to skilled nursing facilities, 3.8% to home health care, and 0.6% to inpatient rehabilitation facilities. Complications included dislocation (0.8%), periprosthetic fracture (0.8%), and deep vein thrombosis (0.2 %). There were no infections reported. CONCLUSIONS Patients implanted using this tissue-sparing technique experienced reduced 30-day all-cause readmission rates (2.3% vs. 4.2%) and more were routinely discharged home (91.5% vs. 27.3%) than have been previously reported for patients in the United States. Use of this tissue-sparing technique has the potential to significantly reduce post-discharge costs.
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Affiliation(s)
- Wade Gofton
- Ottawa Hospital - Civic Campus, J153-1053 Carling Ave., Ottawa, ON, K1Y4E9, Canada
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Wang C, Han Z, Zhang T, Ma JX, Jiang X, Wang Y, Ma XL. The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis. J Orthop Surg Res 2014; 9:90. [PMID: 25316253 PMCID: PMC4212119 DOI: 10.1186/s13018-014-0090-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/22/2014] [Indexed: 11/10/2022] Open
Abstract
Purpose Total knee arthroplasty (TKA) is a popular procedure in severe osteoarthritis. But perioperative bleeding remains a problem. Floseal® is a mixture of thrombin and bovine gelatin which can benefit a lot on reducing intraoperative and postoperative bleeding. However, there is no enough evidence judging its safety and efficiency. So a meta-analysis is conducted by us to evaluate the efficacy and safety of a thrombin-based hemostatic agent compared with conventional methods in TKA. Method Two independent reviewers selected literatures published before August 2014 from MEDLINE, Embase, and The Cochrane Central Register of Controlled Trials. Other internet databases were also performed to identify trials according to the Cochrane Collaboration guidelines. High-quality randomized controlled trials (RCTs), prospective control trials (PCTs), and case controlled trials (CCTs) were selected. The meta-analysis was undertaken using RevMan 5.1 for Windows. Results Three RCTs, one PCT, and one CCT met the inclusion criteria. There were significant differences in hemoglobin decline and calculated total blood loss between the Floseal® group and control group. There were no significant differences in postoperative drainage volume, rate of transfusion requirement, incidence of wound infection, deep vein thrombosis (DVT), and pulmonary embolism (PE) between treatment and control groups. Conclusions The present meta-analysis indicates that a thrombin-based hemostatic agent can reduce hemoglobin decline and calculated total blood loss after TKA and is not related to adverse reactions or complications such as wound infection, DVT, and PE.
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Affiliation(s)
- Chen Wang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. .,Tianjin Medical University, Tianjin, 300070, People's Republic of China.
| | - Zhe Han
- Department of Orthopedics, Tianjin Hospital, Tianjin, 300211, People's Republic of China.
| | - Tao Zhang
- General Hospital of Tianjin Medical University, Tianjin, 300052, People's Republic of China.
| | - Jian-xiong Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.
| | - Xuan Jiang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.
| | - Ying Wang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.
| | - Xin-long Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.
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