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Lloyd TD, Geneen LJ, Bernhardt K, McClune W, Fernquest SJ, Brown T, Dorée C, Brunskill SJ, Murphy MF, Palmer AJ. Cell salvage for minimising perioperative allogeneic blood transfusion in adults undergoing elective surgery. Cochrane Database Syst Rev 2023; 9:CD001888. [PMID: 37681564 PMCID: PMC10486190 DOI: 10.1002/14651858.cd001888.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Concerns regarding the safety and availability of transfused donor blood have prompted research into a range of techniques to minimise allogeneic transfusion requirements. Cell salvage (CS) describes the recovery of blood from the surgical field, either during or after surgery, for reinfusion back to the patient. OBJECTIVES To examine the effectiveness of CS in minimising perioperative allogeneic red blood cell transfusion and on other clinical outcomes in adults undergoing elective or non-urgent surgery. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two clinical trials registers for randomised controlled trials (RCTs) and systematic reviews from 2009 (date of previous search) to 19 January 2023, without restrictions on language or publication status. SELECTION CRITERIA We included RCTs assessing the use of CS compared to no CS in adults (participants aged 18 or over, or using the study's definition of adult) undergoing elective (non-urgent) surgery only. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 106 RCTs, incorporating data from 14,528 participants, reported in studies conducted in 24 countries. Results were published between 1978 and 2021. We analysed all data according to a single comparison: CS versus no CS. We separated analyses by type of surgery. The certainty of the evidence varied from very low certainty to high certainty. Reasons for downgrading the certainty included imprecision (small sample sizes below the optimal information size required to detect a difference, and wide confidence intervals), inconsistency (high statistical heterogeneity), and risk of bias (high risk from domains including sequence generation, blinding, and baseline imbalances). Aggregate analysis (all surgeries combined: primary outcome only) Very low-certainty evidence means we are uncertain if there is a reduction in the risk of allogeneic transfusion with CS (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.59 to 0.72; 82 RCTs, 12,520 participants). Cancer: 2 RCTs (79 participants) Very low-certainty evidence means we are uncertain whether there is a difference for mortality, blood loss, infection, or deep vein thrombosis (DVT). There were no analysable data reported for the remaining outcomes. Cardiovascular (vascular): 6 RCTs (384 participants) Very low- to low-certainty evidence means we are uncertain whether there is a difference for most outcomes. No data were reported for major adverse cardiovascular events (MACE). Cardiovascular (no bypass): 6 RCTs (372 participants) Moderate-certainty evidence suggests there is probably a reduction in risk of allogeneic transfusion with CS (RR 0.82, 95% CI 0.69 to 0.97; 3 RCTs, 169 participants). Very low- to low-certainty evidence means we are uncertain whether there is a difference for volume transfused, blood loss, mortality, re-operation for bleeding, infection, wound complication, myocardial infarction (MI), stroke, and hospital length of stay (LOS). There were no analysable data reported for thrombosis, DVT, pulmonary embolism (PE), and MACE. Cardiovascular (with bypass): 29 RCTs (2936 participants) Low-certainty evidence suggests there may be a reduction in the risk of allogeneic transfusion with CS, and suggests there may be no difference in risk of infection and hospital LOS. Very low- to moderate-certainty evidence means we are uncertain whether there is a reduction in volume transfused because of CS, or if there is any difference for mortality, blood loss, re-operation for bleeding, wound complication, thrombosis, DVT, PE, MACE, and MI, and probably no difference in risk of stroke. Obstetrics: 1 RCT (1356 participants) High-certainty evidence shows there is no difference between groups for mean volume of allogeneic blood transfused (mean difference (MD) -0.02 units, 95% CI -0.08 to 0.04; 1 RCT, 1349 participants). Low-certainty evidence suggests there may be no difference for risk of allogeneic transfusion. There were no analysable data reported for the remaining outcomes. Orthopaedic (hip only): 17 RCTs (2055 participants) Very low-certainty evidence means we are uncertain if CS reduces the risk of allogeneic transfusion, and the volume transfused, or if there is any difference between groups for mortality, blood loss, re-operation for bleeding, infection, wound complication, prosthetic joint infection (PJI), thrombosis, DVT, PE, stroke, and hospital LOS. There were no analysable data reported for MACE and MI. Orthopaedic (knee only): 26 RCTs (2568 participants) Very low- to low-certainty evidence means we are uncertain if CS reduces the risk of allogeneic transfusion, and the volume transfused, and whether there is a difference for blood loss, re-operation for bleeding, infection, wound complication, PJI, DVT, PE, MI, MACE, stroke, and hospital LOS. There were no analysable data reported for mortality and thrombosis. Orthopaedic (spine only): 6 RCTs (404 participants) Moderate-certainty evidence suggests there is probably a reduction in the need for allogeneic transfusion with CS (RR 0.44, 95% CI 0.31 to 0.63; 3 RCTs, 194 participants). Very low- to moderate-certainty evidence suggests there may be no difference for volume transfused, blood loss, infection, wound complication, and PE. There were no analysable data reported for mortality, re-operation for bleeding, PJI, thrombosis, DVT, MACE, MI, stroke, and hospital LOS. Orthopaedic (mixed): 14 RCTs (4374 participants) Very low- to low-certainty evidence means we are uncertain if there is a reduction in the need for allogeneic transfusion with CS, or if there is any difference between groups for volume transfused, mortality, blood loss, infection, wound complication, PJI, thrombosis, DVT, MI, and hospital LOS. There were no analysable data reported for re-operation for bleeding, MACE, and stroke. AUTHORS' CONCLUSIONS In some types of elective surgery, cell salvage may reduce the need for and volume of allogeneic transfusion, alongside evidence of no difference in adverse events, when compared to no cell salvage. Further research is required to establish why other surgeries show no benefit from CS, through further analysis of the current evidence. More large RCTs in under-reported specialities are needed to expand the evidence base for exploring the impact of CS.
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Affiliation(s)
- Thomas D Lloyd
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Louise J Geneen
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | | | | | - Scott J Fernquest
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Tamara Brown
- School of Health, Leeds Beckett University, Leeds, UK
| | - Carolyn Dorée
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Susan J Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Michael F Murphy
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
- Blood and Transplant Research Unit in Data Driven Transfusion, NIHR, Oxford, UK
| | - Antony Jr Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Blood and Transplant Research Unit in Data Driven Transfusion, NIHR, Oxford, UK
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Do autologous blood transfusion systems reduce allogeneic blood transfusion in total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 2017; 25:2957-2966. [PMID: 27085359 DOI: 10.1007/s00167-016-4116-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To study whether autologus blood transfusion systems reduce the requirement of allogneic blood transfusion in patients undergoing total knee arthroplasty. METHODS A comprehensive search of the published literature with PubMed, Scopus and Science direct database was performed. The following search terms were used: (total knee replacement) OR (total knee arthroplasty) OR (TKA) AND (blood transfusion) OR (autologous transfusion) OR (autologous transfusion system). Using search syntax, a total of 748 search results were obtained (79 from PubMed, 586 from Science direct and 83 from Scopus). Twenty-one randomized control trials were included for this meta-analysis. RESULTS The allogenic transfusion rate in autologus blood transfusion (study) group was significantly lower than the control group (28.4 and 53.5 %, respectively) (p value 0.0001, Relative risk: 0.5). The median units of allogenic blood transfused in study control group and control group were 0.1 (0.1-3.0) and 1.3 (0.3-2.6), respectively. The median hospital stay in study group was 9 (6.7-15.6) days and control group was 8.7 (6.6-16.7) days. The median cost incurred for blood transfusion per patient in study and control groups was 175 (85.7-260) and 254.7 (235-300) euros, respectively. CONCLUSION This meta-analysis demonstrates that the use of auto-transfusion systems is a cost-effective method to reduce the need for and quantity of allogenic transfusion in elective total knee arthroplasty. LEVEL OF EVIDENCE Level I.
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Pan JK, Hong KH, Xie H, Luo MH, Guo D, Liu J. The efficacy and safety of autologous blood transfusion drainage in patients undergoing total knee arthroplasty: a meta-analysis of 16 randomized controlled trials. BMC Musculoskelet Disord 2016; 17:452. [PMID: 27806693 PMCID: PMC5094026 DOI: 10.1186/s12891-016-1301-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background Autologous blood transfusion drainage (ABTD) has been used for many years to reduce blood loss in total knee arthroplasty (TKA). We evaluate the current evidence concerning the efficiency and safety of ABTD used in TKA compared with conventional suction drainage (CSD). Methods We performed a systematic literature search of the PubMed, Embase, Cochrane Library and four Chinese databases. All randomized controlled trials (RCTs) that compared the effects of ABTD versus CSD in TKA were included in the meta-analysis. Results Sixteen RCTs involving 1534 patients who compared the effects of ABTD versus CSD were included. Five of the RCTs were performed in Asia, ten in Europe, and one in North America. Patients in the ABTD group had a lower blood transfusion rate (OR: 0.25 [0.13, 0.47]; Z = 4.27, P < 0.0001) and fewer units transfused per patient (WMD: −0.68 [−0.98, −0.39]; Z = 4. 52, P < 0.00001) than did patients in the CSD group. Wound complications, deep vein thrombosis, febrile complications, post-operative hemoglobin days 5–8, drainage volume, and length of hospital stay did not differ significantly between the two types of drainage systems. Conclusion This meta-analysis suggests that ABTD is a safe and effective method that yields a lower blood transfusion rate and fewer units transfused per patient in TKA compared with CSD. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1301-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jian-Ke Pan
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, China
| | - Kun-Hao Hong
- Department of Orthopedics, Guangdong Second Traditional Chinese Medicine Hospital, No. 60 Hengfu Road, Guangzhou, Guangdong, 510095, China
| | - Hui Xie
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, China
| | - Ming-Hui Luo
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, China
| | - Da Guo
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, China
| | - Jun Liu
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), No. 111 Dade Road, Guangzhou, Guangdong, 510120, China.
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Liu D, Dan M, Martinez Martos S, Beller E. Blood Management Strategies in Total Knee Arthroplasty. Knee Surg Relat Res 2016; 28:179-87. [PMID: 27595070 PMCID: PMC5009041 DOI: 10.5792/ksrr.2016.28.3.179] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/21/2015] [Accepted: 01/18/2016] [Indexed: 01/09/2023] Open
Abstract
A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.
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Affiliation(s)
- David Liu
- Gold Coast Centre for Bone and Joint Surgery, Queensland, Australia
| | - Michael Dan
- John Hunter Hospital, New South Wales, Australia
| | | | - Elaine Beller
- Centre for Research in Evidence-Based Practice Bond University, Queensland, Australia
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Kamath AF, Pagnano MW. Blood Management for Patients Undergoing Total Joint Arthroplasty. JBJS Rev 2016; 1:01874474-201312000-00001. [PMID: 27490505 DOI: 10.2106/jbjs.rvw.m.00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Atul F Kamath
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Gonda 14, Rochester, MN 55905
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Hong KH, Pan JK, Yang WY, Luo MH, Xu SC, Liu J. Comparison between autologous blood transfusion drainage and closed-suction drainage/no drainage in total knee arthroplasty: a meta-analysis. BMC Musculoskelet Disord 2016; 17:142. [PMID: 27476506 PMCID: PMC4968028 DOI: 10.1186/s12891-016-0993-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 03/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Autologous blood transfusion (ABT) drainage system is a new unwashed salvaged blood retransfusion system for total knee replacement (TKA). However, whether to use ABT drainage, closed-suction (CS) drainage or no drainage in TKA surgery remains controversial. This is the first meta-analysis to assess the clinical efficiency, safety and potential advantages regarding the use of ABT drains compared with closed-suction/no drainage. Methods PubMed, Embase, and the Cochrane Library were comprehensively searched in March 2015. Fifteen randomized controlled trials (RCTs) were identified and pooled for statistical analysis. The primary outcome evaluated was homologous blood transfusion rate. The secondary outcomes were post-operative haemoglobin on days 3–5, length of hospital stay and wound infections after TKA surgery. Results The pooled data included 1,721 patients and showed that patients in the ABT drainage group might benefit from lower blood transfusion rates (16.59 % and 37.47 %, OR: 0.28 [0.14, 0.55]; 13.05 % and 16.91 %, OR: 0.73 [0.47,1.13], respectively). Autologous blood transfusion drainage and closed-suction drainage/no drainage have similar clinical efficacy and safety with regard to post-operative haemoglobin on days 3–5, length of hospital stay and wound infections. Conclusions Autologous blood transfusion drainage offers a safe and efficient alternative to CS/no drainage with a lower blood transfusion rate. Future large-volume high-quality RCTs with extensive follow-up will affirm and update this system review. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-0993-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kun-Hao Hong
- Department of Orthopedic Surgery, Guangdong Second Traditional Chinese Medicine Hospital, No. 60 Hengfu Road, Guangzhou, Guangdong, 510095, China
| | - Jian-Ke Pan
- Department of Orthopedic Surgery, Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, No. 111 Dade Road,, Guangzhou, Guangdong, 510120, China
| | - Wei-Yi Yang
- Department of Orthopedic Surgery, Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, No. 111 Dade Road,, Guangzhou, Guangdong, 510120, China
| | - Ming-Hui Luo
- Department of Orthopedic Surgery, Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, No. 111 Dade Road,, Guangzhou, Guangdong, 510120, China
| | - Shu-Chai Xu
- Department of Orthopedic Surgery, Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, No. 111 Dade Road,, Guangzhou, Guangdong, 510120, China
| | - Jun Liu
- Department of Orthopedic Surgery, Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, No. 111 Dade Road,, Guangzhou, Guangdong, 510120, China.
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Postoperative Autologous Reinfusion in Total Knee Replacement. JOURNAL OF BLOOD TRANSFUSION 2015; 2015:826790. [PMID: 26442168 PMCID: PMC4579317 DOI: 10.1155/2015/826790] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/10/2015] [Accepted: 08/24/2015] [Indexed: 12/03/2022]
Abstract
Surgeries for total knee replacement (TKR) are increasing and in this context there is a need to develop new protocols for management and use of blood transfusion therapy. Autologous blood reduces the need for allogeneic blood transfusion and the aim of the present study was to verify the safety and the clinical efficacy. An observational retrospective study has been conducted on 124 patients, undergoing cemented total knee prosthesis replacement. Observed population was stratified into two groups: the first group received reinfusion of autologous blood collected in the postoperative surgery and the second group did not receive autologous blood reinfusion. Analysis of data shows that patients undergoing autologous blood reinfusion received less homologous blood bags (10.6% versus 30%; p = 0.08) and reduced days of hospitalization (7.88 ± 0.7 days versus 8.96 ± 2.47 days for the control group; p = 0.03). Microbiological tests were negative in all postoperatively salvaged and reinfused units. Our results emphasize the effectiveness of this procedure and have the characteristics of simplicity, low cost (€97.53 versus €103.79; p < 0.01), and easy reproducibility. Use of autologous drainage system postoperatively is a procedure that allows reducing transfusion of homologous blood bags in patients undergoing TKR.
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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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van Bodegom-Vos L, Voorn VM, So-Osman C, Vliet Vlieland TP, Dahan A, Koopman-van Gemert AW, Vehmeijer SB, Nelissen RG, Marang-van de Mheen PJ. Cell Salvage in Hip and Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. J Bone Joint Surg Am 2015; 97:1012-21. [PMID: 26085536 DOI: 10.2106/jbjs.n.00315] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cell salvage is used to reduce allogeneic red blood-cell (RBC) transfusions in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We performed a meta-analysis to assess the effectiveness of cell salvage to reduce transfusions in THA and TKA separately, and to examine whether recent trials change the conclusions from previous meta-analyses. METHODS We searched MEDLINE through January 2013 for randomized clinical trials evaluating the effects of cell salvage in THA and TKA. Trial results were extracted using standardized forms and pooled using a random-effects model. Methodological quality of the trials was evaluated using the Cochrane Collaboration's tool for risk-of-bias assessment. RESULTS Forty-three trials (5631 patients) were included. Overall, cell salvage reduced the exposure to allogeneic RBC transfusion in THA (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.51 to 0.85) and TKA (RR, 0.51; 95% CI, 0.39 to 0.68). However, trials published in 2010 to 2012, with a lower risk of bias, showed no significant effect of cell salvage in THA (RR, 0.82; 95% CI, 0.66 to 1.02) and TKA (RR, 0.91; 95% CI, 0.63 to 1.31), suggesting that the treatment policy regarding transfusion may have changed over time. CONCLUSIONS Looking at all trials, cell salvage still significantly reduced the RBC exposure rate and the volume of RBCs transfused in both THA and TKA. However, in trials published more recently (2010 to 2012), cell salvage reduced neither the exposure rate nor the volume of RBCs transfused in THA and TKA, most likely explained by changes in blood transfusion management.
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Affiliation(s)
- Leti van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for L. van Bodegom-Vos:
| | - Veronique M Voorn
- Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for L. van Bodegom-Vos:
| | - Cynthia So-Osman
- Sanquin Research, Jon J. van Rood Netherlands Center for Clinical Transfusion Research, Plesmanlaan 1a, 2333 BZ Leiden, the Netherlands
| | - Thea P Vliet Vlieland
- Department of Orthopedics, Leiden University Medical Center, J11-R, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, P5-Q, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Ankie W Koopman-van Gemert
- Department of Anesthesiology, Albert Schweitzer Hospital Dordrecht, P.O. Box 444, 3300 AK Dordrecht, the Netherlands
| | - Stephan B Vehmeijer
- Department of Orthopedics, Reinier de Graaf Hospital Delft, P.O. Box 5011, 2600 GA Delft, the Netherlands
| | - Rob G Nelissen
- Department of Orthopedics, Leiden University Medical Center, J11-R, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Perla J Marang-van de Mheen
- Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for L. van Bodegom-Vos:
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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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Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2014; 38:1603-8. [PMID: 24817099 DOI: 10.1007/s00264-014-2359-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The goal of this study was to analyse the efficacy of blood autotransfusion using a continuous autologous transfusion system in revisions of total hip arthroplasty (THA). We looked at whether administration of allogeneic blood units was reduced in these cases and if there is a difference between cemented and non-cemented revisions. METHODS Between January 2011 and December 2011, patients being treated with revision THA were included (n = 411). The following parameters were analysed: patient age, gender, weight (kg), height (cm), body mass index (BMI, kg/m(2)), surgical diagnosis, treatment and American Society of Anesthesiologists (ASA) classification score. The difference between pre- and post-operative haemoglobin (Hb, g/dl), amount of peri-operative blood loss (ml), amount of retransfused washed shed blood and amount of allogeneic and/or autologous transfusion (ml) were recorded. RESULTS In both the cemented and non-cemented revision THA groups, there was no significant difference between pre- and post-operative Hb with or without using an autotransfusion system. In 92 of 186 cemented cases using an autologous transfusion system (49.5%) and 38 of 117 non-cemented cases using an autologous transfusion system (32.5%), allogeneic blood transfusion (ABT) was required. Cemented procedures using an autologous transfusion system got significantly more ABTs than non-cemented procedures using an autologous transfusion system (p = 0.0042, odds ratio = 2.035). CONCLUSIONS Use of an autologous transfusion system did not reduce the amount of ABT in revision THA in the patient cohort reported here. In our opinion, general blood management is required before and during surgery to reduce administration of ABT.
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Kim GH, Park SW, Kim JH, In Y. The efficacy of unilateral use of a blood reinfusion device in one-stage bilateral total knee arthroplasty. Knee Surg Relat Res 2014; 26:7-12. [PMID: 24639941 PMCID: PMC3953528 DOI: 10.5792/ksrr.2014.26.1.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/22/2014] [Accepted: 01/24/2014] [Indexed: 11/02/2022] Open
Abstract
PURPOSE To assess the efficacy of unilateral use of a blood reinfusion device in one-stage bilateral total knee arthroplasty (TKA). MATERIALS AND METHODS We carried out a retrospective cohort study on 100 patients having one-stage bilateral TKA. In 50 of these patients (study group), a blood reinfusion device was applied on one knee and a standard suction drain on the other, and they were compared with 50 matched controls who received bilateral suction drains (control group). The hemoglobin (Hb) level, the hematocrit (Hct) and the platelet count were checked preoperatively, immediately postoperatively, and the third and seventh days postoperatively. The total drain output and the amount of allogeneic blood transfusion were also compared. RESULTS There were no significant differences in the total drain output and required amount of allogeneic blood transfusions between groups (p>0.05). However, the study group had significantly lower Hb and Hct values by the first day postoperatively and significantly lower platelet count values by the third day postoperatively than the control group (p<0.05). CONCLUSIONS Compared with use of bilateral suction drains, unilateral use of reinfusion device was not advantageous in reducing allogeneic transfusion in one-stage bilateral TKA.
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Affiliation(s)
- Geon-Hyeong Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Se-Wook Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jong-Ho Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Cip J, Widemschek M, Benesch T, Waibel R, Martin A. Does single use of an autologous transfusion system in TKA reduce the need for allogenic blood?: a prospective randomized trial. Clin Orthop Relat Res 2013; 471:1319-25. [PMID: 23229426 PMCID: PMC3586038 DOI: 10.1007/s11999-012-2729-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 11/26/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mechanical autotransfusion systems for washed shed blood (WSB) were introduced to reduce the need for postoperative allogenic blood transfusions (ABTs). Although some authors have postulated decreased requirements for ABT by using autologous retransfusion devices, other trials, mostly evaluating retransfusion devices for unwashed shed blood (USB), verified a small or no benefit in reducing the need for postoperative ABT. Because of these contradictory findings it is still unclear whether autologous retransfusion systems for WSB can reduce transfusion requirements. QUESTIONS/PURPOSES We therefore asked whether one such autologous transfusion system for WSB can reduce the requirements for postoperative ABT. METHODS In a prospective, randomized, controlled study, we enrolled 151 patients undergoing TKA. In Group A (n=76 patients), the autotransfusion system was used for a total of 6 hours (intraoperatively and postoperatively) and the WSB was retransfused after processing. In Control Group B (n=75 patients), a regular drain without suction was used. We used signs of anemia and/or a hemoglobin value less than 8 g/dL as indications for transfusion. If necessary, we administered one or two units of allogenic blood. RESULTS Twenty-three patients (33%) in Group A, who received an average of 283 mL (range, 160-406 mL) of salvaged blood, needed a mean of 2.1 units of allogenic blood, compared with 23 patients (33%) in Control Group B who needed a mean of 2.1 units of allogenic blood. CONCLUSIONS We found the use of an autotransfusion system did not reduce the rate of postoperative ABTs. LEVEL OF EVIDENCE Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Johannes Cip
- />Department of Orthopaedic Surgery, Academic Teaching Hospital, Medical University of Innsbruck, Carinagasse 47, A-6800 Feldkirch, Austria
| | - Mark Widemschek
- />Department of Orthopaedic Surgery, Academic Teaching Hospital, Medical University of Innsbruck, Carinagasse 47, A-6800 Feldkirch, Austria
| | - Thomas Benesch
- />Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Roman Waibel
- />Sport Orthopaedic Clinic Bern, Münsingen, Switzerland
| | - Arno Martin
- />Department of Orthopaedic Surgery, Academic Teaching Hospital, Medical University of Innsbruck, Carinagasse 47, A-6800 Feldkirch, Austria
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Haien Z, Yong J, Baoan M, Mingjun G, Qingyu F. Post-operative auto-transfusion in total hip or knee arthroplasty: a meta-analysis of randomized controlled trials. PLoS One 2013; 8:e55073. [PMID: 23372816 PMCID: PMC3555861 DOI: 10.1371/journal.pone.0055073] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 12/18/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Total hip or knee arthroplasty is an elective procedure that is usually accompanied by substantial blood loss, which may lead to acute anemia. As a result, almost half of total joint arthroplasty patients receive allogeneic blood transfusions (ABT). Many studies have shown that post-operative auto-transfusion (PAT) significantly reduces the need for ABT, but other studies have questioned the efficacy of this method. METHODS The protocol for this trial and supporting CONSORT checklist are available as supporting information; see Checklist S1. To evaluate the efficacy of PAT, we conducted a Cochrane systematic review that combined all available data from randomized controlled trials. Data from the six included trials were pooled for analysis. We then calculated relative risks with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences with 95% CIs for continuous outcomes. FINDINGS AND CONCLUSION To our knowledge, this is the first meta-analysis to compare the clinical results between PAT and a control in joint replacement patients. This meta-analysis has proven that the use of a PAT reinfusion system reduced significantly the demand for ABT, the number of patients who require ABT and the cost of hospitalization after total knee and hip arthroplasty. This study, together with other previously published data, suggests that PAT drains are beneficial. Larger, sufficiently powered studies are necessary to evaluate the presumed reduction in the incidence of infection as well as DVT after joint arthroplasty with the use of PAT.
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Affiliation(s)
- Zhao Haien
- Department of Orthopaedic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Jiang Yong
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi’an, China
| | - Ma Baoan
- Department of Orthopaedic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Guo Mingjun
- Department of Orthopaedic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Fan Qingyu
- Department of Orthopaedic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
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Bruce W, Campbell D, Daly D, Isbister J. Practical recommendations for patient blood management and the reduction of perioperative transfusion in joint replacement surgery. ANZ J Surg 2012; 83:222-9. [DOI: 10.1111/ans.12000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2012] [Indexed: 12/20/2022]
Affiliation(s)
- Warwick Bruce
- Concord Repatriation General Hospital; Sydney; New South Wales; Australia
| | - David Campbell
- Wakefield Orthopaedic Clinic; Adelaide; South Australia; Australia
| | - David Daly
- Alfred Hospital; Melbourne; Victoria; Australia
| | - James Isbister
- Royal North Shore Hospital and Sydney Medical School; Sydney; New South Wales; Australia
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16
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Horstmann WG, Kuipers BM, Slappendel R, Castelein RM, Kollen BJ, Verheyen CCPM. Postoperative autologous blood transfusion drain or no drain in primary total hip arthroplasty? A randomised controlled trial. INTERNATIONAL ORTHOPAEDICS 2012; 36:2033-9. [PMID: 22790978 PMCID: PMC3460103 DOI: 10.1007/s00264-012-1613-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 06/20/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE Postoperative maintenance of high haemoglobin (Hb) levels and avoidance of homologous blood transfusions is important in total hip arthroplasty (THA). The introduction of a postoperative drainage autologous blood transfusion (ABT) system or no drainage following THA has resulted in reduction of homologous blood transfusion requirements compared with closed-suction drains. The purpose of this study was to examine which regimen is superior following THA. METHODS A randomised controlled blinded prospective single-centre study was conducted in which 100 THA patients were randomly allocated to ABT or no drainage. The primary endpoint was the Hb level on the first postoperative day. RESULTS The postoperative collected drained blood loss was 274 (±154) ml in the ABT group, of which 129 (±119) ml was retransfused (0-400). There was no statistical difference in Hb levels on the first postoperative day (ABT vs no drainage: Hb 11.0 vs 10.9 g/dl), on consecutive days (day 3: Hb 10.7 vs 10.2, p = 0.08) or in total blood loss (1,506 vs 1,633 ml), homologous transfusions, pain scores, Harris Hip Score, SF-36 scores, length of hospital stay or adverse events. CONCLUSIONS The use of a postoperative autologous blood retransfusion drain did not result in significantly higher postoperative Hb levels or in less total blood loss or fewer homologous blood transfusions compared with no drain.
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Markar SR, Jones GG, Karthikesalingam A, Segaren N, Patel RV. Transfusion drains versus suction drains in total knee replacement: meta-analysis. Knee Surg Sports Traumatol Arthrosc 2012; 20:1766-72. [PMID: 22072326 DOI: 10.1007/s00167-011-1761-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 10/28/2011] [Indexed: 01/19/2023]
Abstract
PURPOSE The use of autologous blood transfusion drains in orthopaedic surgery has been the subject of debate for several years. The aim of this meta-analysis was to review the use of autologous blood transfusion drains in total knee replacement. METHODS The primary outcomes were as follows: the number of patients requiring homologous blood transfusion, pre-operative haemoglobin and post-operative haemoglobin days 5-7. The secondary outcome measures for the meta-analysis were drainage volume, length of hospital stay, average number of units transfused per patient, post-operative wound infection, and deep vein thrombosis. RESULTS Eight randomised controlled trials met the inclusion criteria and were included in this analysis. Autologous transfusion drains were associated with a decrease in the number of patients requiring post-operative blood transfusion (pooled odds ratio = 0.36, 95% CI = 0.15-0.85, P = 0.02), the number of units transfused per patient (weighted mean difference = -0.84 (95% CI = -1.13 to -0.56), P < 0.0001), and length of hospital stay (weighted mean difference = -0.25 (95% CI = -0.48 to -0.01), P = 0.04). CONCLUSION The results of our study highlight both likely clinical and economic benefits within total knee replacement surgery. The clinical benefits of autologous transfusion drains in the total knee replacement surgery suggested by this meta-analysis include a reduced requirement for post-operative blood transfusion and a shorter length of hospital stay. However, further large-scale high-powered randomized controlled trials are recommended to further elucidate subtle effects of autologous drains on post-operative outcome following total knee replacement. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sheraz R Markar
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK.
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18
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Nash WJ. Autologous blood reinfusion in patients undergoing bilateral total hip arthroplasty. J Orthop Surg (Hong Kong) 2011; 19:395-6; author reply 396. [PMID: 22184183 DOI: 10.1177/230949901101900333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Muñoz M, Slappendel R, Thomas D. Laboratory characteristics and clinical utility of post-operative cell salvage: washed or unwashed blood transfusion? BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:248-61. [PMID: 21084005 PMCID: PMC3136591 DOI: 10.2450/2010.0063-10] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 08/04/2010] [Indexed: 01/18/2023]
Affiliation(s)
- Manuel Muñoz
- International Group of Interdisciplinary Studies about Autotransfusion, Transfusion Medicine, Faculty of Medicine, University of Málaga, Spain.
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20
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Lee DH, Padhy D, Lee SH, Kim TK, Choi J, Han SB. Shed blood re-transfusion provides no benefit in computer-assisted primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19:926-31. [PMID: 20814664 DOI: 10.1007/s00167-010-1228-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE This matched case-cohort retrospective study examined the effectiveness of shed blood re-transfusion in reducing the need for allogeneic blood transfusion in computer-assisted primary cemented total knee arthroplasty (TKA). METHODS The shed blood re-transfusion system used was the cell saver system. Data from 146 cases were analyzed (73 patients with cell saver, 73 patients without cell saver). RESULTS The ABT rate was similar in each group. The mean allogenic blood transfusion volume was similar for each group (CS=214±453 ml, non-CS=288±447 ml). The only factors correlated with allogenic blood transfusion use were low preoperative hemoglobin and low body mass index. Two patients in cell saver group experienced shivering after re-transfusion. CONCLUSION Shed blood re-transfusion provided no blood management benefits in computer-assisted primary TKA and is therefore recommended only for selected patients with low hemoglobin levels and low body mass index.
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Affiliation(s)
- Dae-Hee Lee
- Department of Orthopaedic Surgery, Korea University School of Medicine, Anam Hospital, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul, 136-705, Korea
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21
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Simonsen OH, Gorst-Rasmussen A, Simonsen AB, Jorgensen MB, Rathleff MS, Lundbye-Christensen S. Blood reinfusion combined with femoral nerve block in total knee replacement for patients with increased risk of bleeding. J Orthop Surg (Hong Kong) 2011; 19:64-8. [PMID: 21519080 DOI: 10.1177/230949901101900115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare patients with increased risk of bleeding who received combined blood reinfusion and femoral nerve block in total knee replacement (TKR) to regular patients treated routinely with respect to pain relief, blood loss, and knee function. METHODS In a consecutive series of 67 patients who underwent unilateral TKR, 12 patients with increased risk of bleeding owing to cardiac disease or previous thromboembolic events received continuous femoral nerve block and blood reinfusion, without tranexamic acid (TA) injection. The remaining 55 patients were controls who received standard postoperative treatment (TA injection, local injection of analgesics, and suction drainage without reinfusion). The volume of blood loss (drained or reinfused), pain score (using a visual analogue scale) and knee function (using the Knee Society Score [KSS]) in the 2 groups were compared. RESULTS In the study group, patients were 5 years older and tended to have a lower preoperative KSS function score (35 vs. 45, p=0.08) and a higher function-related pain score (6.5 vs. 6, p=0.10). The mean volume of drained blood wasted in the study group did not differ significantly from the mean total volume of drained blood in the control group (235 vs. 300 ml, p=0.14). Similarly, the mean decrease in postoperative haemoglobin concentration did not differ significantly between the respective groups (2.1 vs. 2.1 mmol/l, p=0.97). A significantly greater proportion of patients received allogenic blood transfusion in the study group than in controls (3/12 vs. 2/55, p<0.01). The study group exhibited significantly higher pain scores during training (1.7 vs. 1.4, p=0.03) and lower escape oxycodone consumption (5 vs. 15 mg/kg, p=0.06) on postoperative day 1 (but not other days). The duration of hospitalisation was also longer (5.5 vs. 4 days, p=0.04). CONCLUSION In TKR patients with increased risk of bleeding, blood reinfusion combined with femoral nerve block is safe and comparable to standard methods of pain control (local injection of analgesics).
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Affiliation(s)
- O H Simonsen
- Orthopaedic Division, North Denmark Region, Aalborg Hospital, Aarhus University, Denmark
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Na HS, Shin SY, Hwang JY, Jeon YT, Kim CS, Do SH. Effects of intravenous iron combined with low-dose recombinant human erythropoietin on transfusion requirements in iron-deficient patients undergoing bilateral total knee replacement arthroplasty (CME). Transfusion 2011; 51:118-24. [DOI: 10.1111/j.1537-2995.2010.02783.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Noyes M, Coffey MJ, Brown DM, Mesghali H. Acute compartment syndrome of the forearm following autologous blood reinfusion: a case report. Hand (N Y) 2010; 5:303-6. [PMID: 19866241 PMCID: PMC2920398 DOI: 10.1007/s11552-009-9237-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 10/09/2009] [Indexed: 11/30/2022]
Abstract
Compartment syndrome is a condition with multiple reported etiologies, and permanent disability may ensue if not treated in a timely fashion. We report the first case, to our knowledge, of acute forearm compartment syndrome caused by intravenous autologous blood reinfusion. The patient underwent forearm fasciotomy, and hematoma was encountered deep to the superficial volar fascia, presumably extravasated from the reinfusion catheter. With the rise in the number of knee and hip arthroplasties, surgeons need a heightened awareness of the possible complications and morbidity associated with a presumed increase in autologous blood reinfusion.
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Affiliation(s)
- Matthew Noyes
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St, Suite 2200, Dayton, OH 45409 USA
| | - Michael J. Coffey
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St, Suite 2200, Dayton, OH 45409 USA
| | - Dennis M. Brown
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St, Suite 2200, Dayton, OH 45409 USA ,Good Samaritan Hospital/Montgomery Orthopaedic Surgeons, Dayton, OH USA
| | - Homayoun Mesghali
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St, Suite 2200, Dayton, OH 45409 USA ,Good Samaritan Hospital/Montgomery Orthopaedic Surgeons, Dayton, OH USA
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Carless PA, Henry DA, Moxey AJ, O'Connell D, Brown T, Fergusson DA. Cell salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2010; 2010:CD001888. [PMID: 20393932 PMCID: PMC4163967 DOI: 10.1002/14651858.cd001888.pub4] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Concerns regarding the safety of transfused blood have prompted reconsideration of the use of allogeneic (from an unrelated donor) red blood cell (RBC) transfusion, and a range of techniques to minimise transfusion requirements. OBJECTIVES To examine the evidence for the efficacy of cell salvage in reducing allogeneic blood transfusion and the evidence for any effect on clinical outcomes. SEARCH STRATEGY We identified studies by searching CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to June 2009), EMBASE (1980 to June 2009), the internet (to August 2009) and bibliographies of published articles. SELECTION CRITERIA Randomised controlled trials with a concurrent control group in which adult patients, scheduled for non-urgent surgery, were randomised to cell salvage (autotransfusion) or to a control group who did not receive the intervention. DATA COLLECTION AND ANALYSIS Data were independently extracted and the risk of bias assessed. Relative risks (RR) and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Data were pooled using a random-effects model. The primary outcomes were the number of patients exposed to allogeneic red cell transfusion and the amount of blood transfused. Other clinical outcomes are detailed in the review. MAIN RESULTS A total of 75 trials were included. Overall, the use of cell salvage reduced the rate of exposure to allogeneic RBC transfusion by a relative 38% (RR 0.62; 95% CI 0.55 to 0.70). The absolute reduction in risk (ARR) of receiving an allogeneic RBC transfusion was 21% (95% CI 15% to 26%). In orthopaedic procedures the RR of exposure to RBC transfusion was 0.46 (95% CI 0.37 to 0.57) compared to 0.77 (95% CI 0.69 to 0.86) for cardiac procedures. The use of cell salvage resulted in an average saving of 0.68 units of allogeneic RBC per patient (WMD -0.68; 95% CI -0.88 to -0.49). Cell salvage did not appear to impact adversely on clinical outcomes. AUTHORS' CONCLUSIONS The results suggest cell salvage is efficacious in reducing the need for allogeneic red cell transfusion in adult elective cardiac and orthopaedic surgery. The use of cell salvage did not appear to impact adversely on clinical outcomes. However, the methodological quality of trials was poor. As the trials were unblinded and lacked adequate concealment of treatment allocation, transfusion practices may have been influenced by knowledge of the patients' treatment status potentially biasing the results in favour of cell salvage.
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Affiliation(s)
- Paul A Carless
- Faculty of Health, University of NewcastleDiscipline of Clinical PharmacologyLevel 5, Clinical Sciences Building, Newcastle Mater HospitalEdith Street, WaratahNewcastleNew South WalesAustralia2298
| | - David A Henry
- Institute of Clinical Evaluative Sciences2075 Bayview AvenueG1 06TorontoOntarioCanadaM4N 3M5
| | - Annette J Moxey
- Faculty of Health, University of NewcastleResearch Centre for Gender, Health & AgeingLevel 2, David Maddison BuildingUniversity DriveCallaghanNew South WalesAustralia2308
| | - Dianne O'Connell
- Cancer CouncilCancer Epidemiology Research UnitPO Box 572Kings CrossSydneyNSWAustralia1340
| | - Tamara Brown
- University of TeessideSchool of Health & Social Care, Centre for Food, Physical Activity and ObesityCenturia BuildingTees ValleyMiddlesbroughUKTS1 3BA
| | - Dean A Fergusson
- University of Ottawa Centre for Transfusion ResearchOttawa Health Research Institute501 Smyth RoadOttawaOntarioCanadaK1H 8L6
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Carless PA, Henry DA, Moxey AJ, O'Connell D, Brown T, Fergusson DA. Cell salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2010:CD001888. [PMID: 20238316 DOI: 10.1002/14651858.cd001888.pub3] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Concerns regarding the safety of transfused blood, have prompted reconsideration of the use of allogeneic (blood from an unrelated donor) red blood cell (RBC) transfusion, and a range of techniques to minimise transfusion requirements. OBJECTIVES To examine the evidence for the efficacy of cell salvage in reducing allogeneic blood transfusion and the evidence for any effect on clinical outcomes. SEARCH STRATEGY We identified studies by searching CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to June 2009), EMBASE (1980 to June 2009), the Internet (to August 2009) and bibliographies of published articles. SELECTION CRITERIA Randomised controlled trials with a concurrent control group in which adult patients, scheduled for non-urgent surgery, were randomised to cell salvage (autotransfusion), or to a control group, who did not receive the intervention. DATA COLLECTION AND ANALYSIS Data were independently extracted and the risk of bias assessed. Relative risks (RR) and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Data were pooled using a random effects model. The primary outcomes were the number of patients exposed to allogeneic red cell transfusion, and the amount of blood transfused. Other clinical outcomes are detailed in the review. MAIN RESULTS A total of 75 trials were included. Overall, the use of cell salvage reduced the rate of exposure to allogeneic RBC transfusion by a relative 38% (RR=0.62: 95% CI 0.55 to 0.70). The absolute reduction in risk (ARR) of receiving an allogeneic RBC transfusion was 21% (95% CI 15% to 26%). In orthopaedic procedures the RR of exposure to RBC transfusion was 0.46 (95% CI 0.37 to 0.57) compared to 0.77 (95% CI 0.69 to 0.86) for cardiac procedures. The use of cell salvage resulted in an average saving of 0.68 units of allogeneic RBC per patient (WMD=-0.68; 95% CI -0.88 to -0.49). Cell salvage did not appear to impact adversely on clinical outcomes. AUTHORS' CONCLUSIONS The results suggest cell salvage is efficacious in reducing the need for allogeneic red cell transfusion in adult elective cardiac and orthopaedic surgery. The use of cell salvage did not appear to impact adversely on clinical outcomes. However, the methodological quality of trials was poor. As the trials were unblinded and lacked adequate concealment of treatment allocation, transfusion practices may have been influenced by knowledge of the patients' treatment status potentially biasing the results in favour of cell salvage.
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Affiliation(s)
- Paul A Carless
- Discipline of Clinical Pharmacology, Faculty of Health, University of Newcastle, Level 5, Clinical Sciences Building, Newcastle Mater Hospital, Edith Street, Waratah, Newcastle, New South Wales, Australia, 2298
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Dutch orthopedic blood management surveys 2002 and 2007: an increasing use of blood-saving measures. Arch Orthop Trauma Surg 2010; 130:55-9. [PMID: 19529950 DOI: 10.1007/s00402-009-0910-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hip and knee arthroplasties are frequently complicated by the need for allogeneic blood transfusions. The surveys were developed to assess the use of blood-saving measures in orthopedic surgery in the Netherlands in 2002 and 2007. STUDY DESIGN AND METHODS In 2002 and 2007, a questionnaire on blood management measures after several orthopedic procedures was sent to all Dutch orthopedic departments (110 and 96, respectively). RESULTS The response was 79% in 2002 and 84% in 2007. The use of preoperative autologous blood donation remained virtually unchanged in 2002 versus 2007 for both hip (10.9 and 10.5%) and knee (5.7 and 8.2%) arthroplasty. In 2007, there was a substantial increase in departments using erythropoietine for hip (31.6–66.1%) as well as knee (24.0–55.5%) arthroplasty. There was an increase of the use of autologous retransfusion of intraoperatively suctioned washed blood in hip (20.3–28.4%) as well as knee arthroplasty (8.9–16.1%) over the 5-year period, but it was predominantly used in revision hip arthroplasty (54.3%). The use of postoperative autologous retransfusion of filtered drained wound blood increased dramatically in 5 years time in hip (11.5–51.0%) and knee arthroplasty (15.9–59.3%). CONCLUSION There is an evident increase in the preoperative use of erythropoietin and the postoperative use of autologous retransfusion of drained blood among Dutch orthopedic departments. There appears to be an increasing awareness and positive attitude among Dutch orthopedic surgeons to implement perioperative blood-saving measures.
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Parker DA, Coolican MRJ, Mather LE, Graham DA, Dewall MJ. Safety of combined use of local anesthetic infiltration and reinfusion drains in total knee arthroplasty. J Arthroplasty 2009; 24:918-24. [PMID: 18701246 DOI: 10.1016/j.arth.2008.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 05/02/2008] [Indexed: 02/01/2023] Open
Abstract
Injection of local anesthetic during total knee arthroplasty (TKA) has been shown to aid postoperative pain relief. Reinfusion drains have also proven useful in decreasing allogenic blood transfusion. Combined use carries the risk of reinfusion of local anesthetic from drainage bag. We examined plasma ropivacaine concentrations from 20 patients undergoing TKA, who were treated with these 2 techniques. Samples were taken from a dedicated venous cannula and from the reinfusion drainage bag. The average amount of ropivacaine reinfused was 1.9 mg, a fraction of the injected dose (150 mg), and venous plasma concentrations reached peaks of 0.5 to 1.5 microg/mL, well below demonstrated levels of toxicity. Patients tolerated the treatment well, with no adverse outcomes. This study demonstrates the safety of combining these 2 techniques in TKA.
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MESH Headings
- Aged
- Aged, 80 and over
- Amides/administration & dosage
- Amides/blood
- Amides/therapeutic use
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/blood
- Anesthetics, Local/therapeutic use
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Blood Transfusion, Autologous/adverse effects
- Blood Transfusion, Autologous/methods
- Dose-Response Relationship, Drug
- Drug Overdose/epidemiology
- Drug Overdose/prevention & control
- Female
- Humans
- Injections, Intra-Articular
- Male
- Middle Aged
- Pain, Postoperative/prevention & control
- Patient Satisfaction
- Retrospective Studies
- Risk Factors
- Ropivacaine
- Treatment Outcome
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Affiliation(s)
- David A Parker
- Sydney Orthopedic Research Institute, Chatswood, NSW, Australia
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Reinfusion of unwashed salvaged blood after total knee arthroplasty in patients with rheumatoid arthritis. INTERNATIONAL ORTHOPAEDICS 2008; 33:1615-8. [PMID: 18853156 DOI: 10.1007/s00264-008-0661-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 08/06/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
Abstract
Autotransfusion with unwashed salvaged blood (USB) is effective for avoiding allogeneic blood transfusion (ABT) in patients undergoing total knee arthroplasty (TKA). We performed a retrospective study to determine the percentage of patients receiving ABT and the volume of postoperative blood drainage after introduction of autotransfusion with USB for patients with rheumatoid arthritis (RA) undergoing TKA. In 100 patients without autotransfusion (group 1) and 100 patients receiving autotransfusion of USB (group 2), we compared the number of patients who required ABT, as well as the postoperative drainage volume, ABT volume, and autotransfusion volume. In group 1, 83% of the patients received ABT, while only 47% received ABT in group 2, and there was a significant decrease (p < 0.001). However, the postoperative drainage volume was significantly increased in group 2 (p < 0.001).
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[Analgaesia, anaesthesia, and rehabilitation for minimally invasive total knee arthroplasty]. DER ORTHOPADE 2007; 36:1149-56. [PMID: 18030447 DOI: 10.1007/s00132-007-1169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Compared with conventional total knee arthroplasty, rehabilitation after a minimally invasive procedure is faster. Flexion to 90 degrees is reached in a few days in most patients. Coordination exercises, stair climbing, and mobilisation with one or no crutches are achieved rapidly, and patients can usually return more quickly to their activities of daily living as well as professional and leisure-time activities. This progress is based on new surgical techniques that protect muscles and tendons. To optimize these results, analgaesia protocols and anaesthesia procedures could be improved, and rehabilitation programs should be individualised. Patient education is best started weeks before surgery because a well-motivated patient supports an excellent clinical outcome. New surgical techniques give us the possibility to think about routinely used perioperative procedures and improve them. The aim is to offer a concept of minimally invasive surgical technique and optimized protocols for perioperative anaesthesia, analgaesia, and rehabilitation.
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