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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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Tió MM, Sánchez-Etayo G, Bergé R, Salazar F, Basora M, Sala-Blanch X. Cost-effectiveness of post-operative cell salvage in total knee arthroplasty. Should we continue to recommend its use today? ACTA ACUST UNITED AC 2016; 63:444-50. [PMID: 26782288 DOI: 10.1016/j.redar.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Total knee arthroplasty (TKA) has a high transfusion rate. In our protocol, the use of postoperative cell salvage is indicated in patients with contraindications to tranexamic acid (TA). An analysis was performed on the effect of post-operative cell salvage (POCS) regarding transfusion rate and costs in patients undergoing TKA. MATERIAL AND METHODS A prospective analysis was conducted on 518 patients, of whom 434 received TA, and 84 were contraindicated. The red cell mass, blood volume, and the percentage of lost blood volume were calculated. Incidents associated with the use of post-operative re-perfusion of drained blood and the rate of transfusion were recorded. An analysis was performed on the costs associated with allogeneic transfusion prevention methods. RESULTS A POCS drain was not inserted in 10 out of the 84 patients not candidates for TA. In the 74 in which it was placed, 158±72ml of red cell mass was reinfused. The allogeneic transfusion rate was 36%, and was 52% in those with no drain inserted. Relative risk of transfusion using POCS was 0.69 (0.41 to 1.16) with an absolute risk reduction of 16% (-8 to 40%). The number needed to treat to avoid allogeneic transfusion was 7. The direct costs to avoid allogeneic transfusion were €1,610. No complications associated with blood re-infusion were observed. CONCLUSIONS The use of POCS would be required in 7 patients after TKA to avoid one allogeneic transfusion with a cost over 10 times that of a transfusion of red cell concentrates.
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Affiliation(s)
- M M Tió
- Departamento de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España.
| | - G Sánchez-Etayo
- Departamento de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
| | - R Bergé
- Departamento de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
| | - F Salazar
- Departamento de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
| | - M Basora
- Departamento de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
| | - X Sala-Blanch
- Departamento de Anestesiología y Reanimación, Hospital Clínic, Barcelona, España
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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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Muñoz M, Iglesias D, Garcia-Erce JA, Cuenca J, Herrera A, Martin-Montañez E, Pavia J. Utility and cost of low-vacuum reinfusion drains in patients undergoing surgery for subcapital hip fracture repair. A before and after cohort study. Vox Sang 2013; 106:83-91. [DOI: 10.1111/vox.12071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/18/2013] [Accepted: 06/24/2013] [Indexed: 12/15/2022]
Affiliation(s)
- M. Muñoz
- GIEMSA; Transfusion Medicine; School of Medicine; University of Málaga; Málaga Spain
| | - D. Iglesias
- Department Orthopaedic and Trauma Surgery; University Hospital Miguel Servet; Zaragoza Spain
| | - J. A. Garcia-Erce
- Section of Haematology and Haemotherapy; General Hospital San Jorge; Huesca Spain
| | - J. Cuenca
- Department Orthopaedic and Trauma Surgery; University Hospital Miguel Servet; Zaragoza Spain
| | - A. Herrera
- Section of Haematology and Haemotherapy; General Hospital San Jorge; Huesca Spain
| | - E. Martin-Montañez
- Department of Pharmacology; School of Medicine; University of Málaga; Málaga Spain
| | - J. Pavia
- Department of Pharmacology; School of Medicine; University of Málaga; Málaga Spain
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Fraga G, Ramos-Luengo A, Miyagi M, Rodríguez-Tato P, Berberana M, González L. [Decrease in allogenic transfusions due to the spread of use of postoperative retransfusion systems in knee replacement surgery]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:308-12. [PMID: 23680661 DOI: 10.1016/j.redar.2013.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/11/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Surgical teams have several tools in order to reduce the need for postoperative allogenic transfusion. Postoperative autotransfusion of unwashed shed blood has become common practice for total knee replacement surgery since 2006 in our hospital. This study was designed to evaluate if this practice has reduced allogenic blood transfusions. MATERIAL AND METHODS A retrospective study comparing two cohorts, group 2004 with patients operated on for total knee replacement during the year 2004, before the use of the retransfusion system, and group 2008, patients operated on in the year 2008, with regular use of the retransfusion system. Gender, preoperative and postoperative haemoglobin levels, total amount of calculated erythrocytes lost, reinfusion of shed blood and allogenic blood transfusion during hospital stay were recorded. RESULTS Both groups were similar as regards gender, preoperative and postoperative hemoglobin levels, and total amount of erythrocytes lost. The proportion of transfused patients was significantly lower in group 2008 versus group 2004 (20.18% versus 42.19%), with a relative risk of being transfused of 0.47 and a NNT of 4.54. P=.0017. CONCLUSIONS In our hospital the use of postoperative retransfusion systems has reduced the proportion of transfused patients during hospitalization for total knee replacement surgery, although this result cannot be generalized due to the lack of a fixed transfusion trigger.
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Affiliation(s)
- G Fraga
- Servicio de Anestesiología y Reanimación, Hospital Severo Ochoa, Leganés, Madrid, España.
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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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Muñoz M, Ariza D, Campos A, Martín-Montañez E, Pavía J. The cost of post-operative shed blood salvage after total knee arthroplasty: an analysis of 1,093 consecutive procedures. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:260-71. [PMID: 23149145 PMCID: PMC3626479 DOI: 10.2450/2012.0139-12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/06/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Requirements for allogeneic red cell transfusion after total knee arthroplasty are still high (20-50%), and salvage and reinfusion of unwashed, filtered post-operative shed blood is an established method for reducing transfusion requirements following this operation. We performed a cost analysis to ascertain whether this alternative is likely to be cost-effective. MATERIALS AND METHODS Data from 1,093 consecutive primary total knee arthroplasties, managed with (reinfusion group, n=763) or without reinfusion of unwashed salvaged blood (control group, n=330), were retrospectively reviewed. The costs of low-vacuum drains, shed blood collection canisters (Bellovac ABT, Wellspect HealthCare and ConstaVac CBC II, Stryker), shed blood reinfusion, acquisition and transfusion of allogeneic red cell concentrate, haemoglobin measurements, and prolonged length of hospital stay were used for the blood management cost analysis. RESULTS Patients in the reinfusion group received 152±64 mL of red blood cells from postoperatively salvaged blood, without clinically relevant incidents, and showed a lower allogeneic transfusion rate (24.5% vs. 8.5%, for the control and reinfusion groups, respectively; p =0.001). There were no differences in post-operative infection rates. Patients receiving allogeneic transfusions stayed in hospital longer (+1.9 days [95% CI: 1.2 to 2.6]). As reinfusion of unwashed salvaged blood reduced the allogeneic transfusion rate, both reinfusion systems may provide net savings in different cost scenarios (€ 4.6 to € 106/patient for Bellovac ABT, and € -51.9 to € 49.9/patient for ConstaVac CBCII). DISCUSSION Return of unwashed salvaged blood after total knee arthroplasty seems to save costs in patients with pre-operative haemoglobin between 12 and 15 g/dL. It is not cost-saving in patients with a pre-operative haemoglobin >15 g/dL, whereas in those with a pre-operative haemoglobin <12 g/dL, although cost-saving, its efficacy could be increased by associating some other blood-saving method.
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Affiliation(s)
- Manuel Muñoz
- GIEMSA, Facultad de Medicina, School of Medicine, University of Málaga, Málaga, Spain.
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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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Harwin SF, Issa K, Naziri Q, Johnson AJ, Mont MA. Results of primary total knee arthroplasty in Jehovah's Witness patients. J Arthroplasty 2013; 28:49-55. [PMID: 22771089 DOI: 10.1016/j.arth.2012.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 05/19/2012] [Indexed: 02/01/2023] Open
Abstract
Total knee arthroplasty can be challenging in Jehovah's Witnesses, as these patients do not accept blood transfusions. We reported our experiences with a special blood management protocol for these patients who underwent total knee arthroplasty. There were 124 self-reported Jehovah's Witnesses who had a mean age of 64 years and who underwent total knee arthroplasties between 1998 and 2009. Mean follow-up was 60 months (range, 24-120 months). Implant survivorship, with revision for aseptic component failure as an end point, was 98%. At the final follow-up, mean Knee Society objective and function score improved to 91 and 81 points, respectively. The authors believe that this blood management protocol was responsible for performing safe and transfusion-free total knee arthroplasties that can ultimately lead to excellent outcomes.
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Affiliation(s)
- Steven F Harwin
- Total Joint Replacement Bloodless Surgery Program, Beth Israel Medical Center, New York, New York, USA
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10
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Muñoz M, Campos A, Merino I. Recovered hemoglobin and hemolysis in filtered or processed shed blood after total knee arthroplasty. Transfusion 2012; 52:1839-41; author reply 1841. [PMID: 22882098 DOI: 10.1111/j.1537-2995.2012.03657.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Rao VK, Dyga R, Bartels C, Waters JH. A cost study of postoperative cell salvage in the setting of elective primary hip and knee arthroplasty. Transfusion 2012; 52:1750-60. [PMID: 22339139 PMCID: PMC3360121 DOI: 10.1111/j.1537-2995.2011.03531.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The increasing costs, limited supply, and clinical risks associated with allogeneic blood transfusion have prompted investigation into autologous blood management strategies, such as postoperative red blood cell (RBC) salvage. This study provides a cost comparison of transfusing washed postoperatively salvaged RBCs using an orthopedic perioperative autotransfusion device (OrthoPat, Haemonetics Corporation) versus unwashed shed blood and banked allogeneic blood. STUDY DESIGN AND METHODS Cell salvage data were retrospectively reviewed for a sample of 392 patients who underwent primary hip or knee arthroplasty. Mean unit costs were calculated for washed salvaged RBCs, equivalent units of unwashed shed blood, and therapeutically equivalent volumes of allogeneic RBCs. RESULTS No initial capital investment was required for the establishment of the postoperative cell salvage program. For patients undergoing total knee arthroplasty (TKA), the mean unit costs for washed postoperatively salvaged cells, unwashed shed blood, and allogeneic banked blood were $758.80, $474.95, and $765.49, respectively. In patients undergoing total hip arthroplasty (THA), the mean unit costs for washed postoperatively salvaged cells, unwashed shed blood, and allogeneic banked blood were $1827.41, $1167.41, and $2609.44, respectively. CONCLUSION This analysis suggests that transfusing washed postoperatively salvaged cells using the OrthoPat device is more costly than using unwashed shed blood in both THA and TKA. When compared to allogeneic transfusion, washed postoperatively salvaged cells carry a comparable cost in TKA, but potentially represent a significant savings in patients undergoing THA. Sensitivity analysis suggests that in the case of TKA, however, cost comparability exists within a narrow range of units collected and infused.
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Affiliation(s)
- Vidya K. Rao
- Department of Anesthesiology, Magee-Women's Hospital University of Pittsburgh Medical Center
| | - Robert Dyga
- Department of Anesthesiology, Magee-Women's Hospital University of Pittsburgh Medical Center
| | - Christopher Bartels
- Department of Anesthesiology, Magee-Women's Hospital University of Pittsburgh Medical Center
| | - Jonathan H. Waters
- Department of Anesthesiology, Magee-Women's Hospital University of Pittsburgh Medical Center
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On the role of iron therapy for reducing allogeneic blood transfusion in orthopaedic surgery. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 10:8-22. [PMID: 22153694 DOI: 10.2450/2011.0061-11] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 07/27/2011] [Indexed: 12/14/2022]
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13
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Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion management of patients in the peri-operative period. III. The post-operative period. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:320-35. [PMID: 21627922 PMCID: PMC3136601 DOI: 10.2450/2011.0076-10] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Giancarlo Maria Liumbruno
- Units of Immunohaematology, Transfusion Medicine and Clinical Pathology, San Giovanni Calibita Fatebenefratelli Hospital, Rome.
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14
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Strategies for reducing transfusions in major orthopaedic surgery. BLOOD TRANSFUSION 2011; 9:246-7. [PMID: 21627926 DOI: 10.2450/2011.0003-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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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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16
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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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Muñoz M, García-Segovia S, Ariza D, Cobos A, García-Erce JA, Thomas D. Sedimentation method for preparation of postoperatively salvaged unwashed shed blood in orthopaedic surgery. Br J Anaesth 2010; 105:457-65. [PMID: 20639211 DOI: 10.1093/bja/aeq174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Salvage and return of unwashed shed blood (USB) after total knee replacement (TKR) is an established blood-saving technique, but some authors question its efficacy and safety and suggest that the shed blood be washed before returning. We evaluated a colloid-based sedimentation method for improving and standardizing the quality of USB collected after TKR without the need for washing. METHODS Experiments were performed to find the optimal colloid dose and sedimentation time using diluted donated venous blood. USB samples (n=52) were drawn from the reinfusion bag and mixed with hydroxyethyl starch or gelatine solutions (15-30%, colloid solution volume/total volume × 100). USB red blood cells (RBCs) were allowed to settle by gravity for 30 min, supernatant was evacuated from the syringe, and RBC concentrate was analysed. RBC recovery and other blood cell and chemical removal were calculated according to changes in USB volume and haematocrit. Twenty-five samples from leucodepleted packed RBCs were analysed as a comparator group. RESULTS Mean haemoglobin (Hb) of USB was 10.9 g dl(-1). After colloid treatment, 90% of RBCs were recovered, and USB Hb was similar to that of leucodepleted packed RBCs (n=25) (18.9 vs 19.6 g dl(-1), respectively; P=NS). In addition, the procedure reduced USB content of leucocytes (60%), platelets (48%), total protein (76%), cytokines (70-77%), and plasma-free haemoglobin (53%), without major differences between colloids. CONCLUSIONS Sedimentation of USB with colloid solutions provides a low-cost alternative for improving and standardizing the quality of salvaged USB after TKR.
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Affiliation(s)
- M Muñoz
- Transfusion Medicine, School of Medicine, University of Málaga, Campus de Teatinos, 29071 Málaga, Spain.
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Blatsoukas KS, Drosos GI, Kazakos K, Papaioakim M, Gioka T, Chloropoulou P, Verettas DA. Prospective comparative study of two different autotransfusion methods versus control group in total knee replacement. Arch Orthop Trauma Surg 2010; 130:733-7. [PMID: 20165861 DOI: 10.1007/s00402-010-1062-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Indexed: 01/16/2023]
Abstract
AIM The aim of this study was to evaluate the efficacy of two different autotransfusion methods in total knee replacement (TKR) performed without tourniquet, in comparison to allogeneic blood transfusion (ABT) only. METHOD In a comparative study, 248 patients with knee osteoarthritis were randomized in three groups: in control Group 85 the patients underwent only ABT post-operatively, in Group 1 (n:92) an intraoperative and postoperative autotransfusion were utilized, and in Group 2 (n:71) only a postoperative autotransfusion was applied. Post-operative ABT was utilized according to predetermined criteria. RESULTS Comparing Group 0 to Group 1 and 2 the difference in need for ABT post-operatively was statistically highly significant (p < 0.001) even when the results were analyzed classifying the patients according to the preoperative Hb levels. The difference between Group 1 and 2 was not significant. CONCLUSION According to the results of this study, auto-transfusion reduces the need for ABT in TKR performed without tourniquet.
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Affiliation(s)
- Konstantinos S Blatsoukas
- Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
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HORSTMANN WIEGERG, SLAPPENDEL ROBERT, VAN HELLEMONDT GIJSG, CASTELEIN RENEM, VERHEYEN CEESC. Safety of retransfusion of filtered shed blood in 1819 patients after total hip or knee arthroplasty. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1778-428x.2010.01130.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Muñoz M, García-Erce JA, Cuenca J. Tranexamic acid for reducing transfusion requirements after total knee arthroplasty: can efficacy and cost ratios be improved? Vox Sang 2009; 95:350-1; author reply 352. [PMID: 19138267 DOI: 10.1111/j.1423-0410.2008.01098.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Muñoz M, García-Erce JA, Villar I, Thomas D. Blood conservation strategies in major orthopaedic surgery: efficacy, safety and European regulations. Vox Sang 2009; 96:1-13. [DOI: 10.1111/j.1423-0410.2008.01108.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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BISBE ELVIRA, CASTILLO JORGE, SÁEZ MONTSERRAT, SANTIVERI XAVIER, RUÍZ AINA, MUÑOZ MANUEL. Prevalence of preoperative anemia and hematinic deficiencies in patients scheduled for elective major orthopedic surgery. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1778-428x.2008.00118.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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SLAPPENDEL ROBERT, HORSTMANN WIEGER, DIRKSEN RIS, VAN HELLEMONDT GIJSG. Wound drainage with or without blood salvage? An open, prospective, randomized and single-center comparison of blood loss, postoperative hemoglobin levels and allogeneic blood transfusions after major hip surgery. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1778-428x.2009.00121.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lozano M, Basora M, Macule F. Answer to ‘Tranexamic acid for reducing transfusion requirements after total knee arthroplasty: can efficacy and cost ratios be improved?’ by Muñozet al. Vox Sang 2008. [DOI: 10.1111/j.1423-0410.2008.01099.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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del Trujillo MM, Carrero A, Muñoz M. The utility of the perioperative autologous transfusion system OrthoPAT in total hip replacement surgery: a prospective study. Arch Orthop Trauma Surg 2008; 128:1031-8. [PMID: 17828546 DOI: 10.1007/s00402-007-0440-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Indexed: 02/09/2023]
Abstract
BACKGROUND Total hip replacement (THR) is associated with a significant perioperative blood loss, and 30-50% of these patients receive allogeneic blood transfusion (ABT). We evaluated the clinical utility of washed shed blood (WSB) return to reduce ABT in THR patients. STUDY DESIGN AND METHODS Data from 108 consecutive THR patients were prospectively collected. WSB salvage and reinfusion (OrthoPAT) was intended for 60 (Reinfusion group), whereas the remaining 48 patients served as control group. Patients received ABT if haemoglobin <8 g/dl or clinical signs and symptoms of acute anemia. RESULTS WSB return was possible in 49 patients (205 +/- 151 ml of erythrocyte/patient), without any clinically relevant incident. Return of WSB decreased both the ABT rate (48 vs. 15%, for control and reinfusion groups, respectively; P = 0.001) and the ABT index (371 +/- 154 ml RBC vs. 53 +/- 117 ml RBC, respectively; P = 0.001), without differences between cemented and uncemented THR. In addition, patients from reinfusion group showed a trend to lower postoperative infection rate (10 vs. 2%, respectively; P = 0.086). CONCLUSIONS Perioperative salvage and return of WSB in THR seems to effectively reduce the requirements for ABT. However, for patients with preoperative Hb < 13 g/dl, some additional blood saving method should be associated to WSB return.
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Kvarnström A, Schmidt A, Tylman M, Jacobsson M, Bengtsson A. Complement split products and proinflammatory cytokines in intraoperatively salvaged unwashed blood during hip replacement: comparison between heparin-coated and non-heparin-coated autotransfusion systems. Vox Sang 2008; 95:33-8. [PMID: 18444947 DOI: 10.1111/j.1423-0410.2008.01059.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of the present study was to investigate the quality of shed blood collected in a new intraoperative autotransfusion system (Sangvia, AstraTech, Sweden) and to study whether heparin-coated surfaces in the device reduce the production of inflammatory mediators. MATERIAL AND METHODS The study was randomized and prospective. Twelve total hip arthroplasty patients whose blood was collected with a device having a heparin-coated surface and 12 patients whose blood was collected with a device having a non-heparin-coated surface were included. Venous blood was drawn from the patients preoperatively. Intraoperatively 200 ml salvaged blood was collected and samples were also withdrawn; samples were obtained from the blood bag. RESULTS Compared to venous blood, elevated concentrations of interleukin 6 (IL-6), IL-8, C3a and polymorphonuclear elastase were found in collected blood. No significant differences in inflammatory mediators were found between the heparin-coated and the non-heparin-coated groups. The median haemoglobin concentration in the salvaged blood was 74 g/l in both groups. Plasma haemoglobin and potassium concentrations were also elevated. There were no significant differences between the groups. CONCLUSION The present study indicates that the blood salvaged intraoperatively contains elevated levels of complement split product and proinflammatory cytokines and that heparin-coated surfaces of the salvage device do not significantly influence the formation of inflammatory mediators.
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Affiliation(s)
- A Kvarnström
- Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital/East, Goteborg, Sweden
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BASORA MISERICORDIA, COLOMINA MARÍAJ, MORAL VICTORIA, LLAU JUANV, VILA MIGUEL, DURÁN LOURDES, SILVA SONSOLES, SÁNCHEZ CALIXTOA. Descriptive study of perioperative transfusion practices in Spanish hospitals. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1778-428x.2008.00093.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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