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Iyer NS, Khanuja K, Roman A, Al-Kouatly HB. Use of cell salvage at the time of cesarean delivery: a meta-analysis of randomized controlled trials. Am J Obstet Gynecol MFM 2024; 6:101257. [PMID: 38109996 DOI: 10.1016/j.ajogmf.2023.101257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE Excess blood loss from obstetrical hemorrhage requires transfusion of donor blood, a finite resource. Intraoperative cell salvage collects a patient's own blood that has been lost during cesarean delivery and returns it to their own circulation. We performed a meta-analysis to examine the perioperative outcomes in patients receiving cell salvage at the time of cesarean delivery. DATA SOURCES Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid Medline, and clinicaltrials.gov were searched from database inception through October 2023. STUDY ELIGIBILITY CRITERIA Eligible studies included randomized controlled trials comparing the use of cell salvage to standard-of-care during cesarean delivery. METHODS Two authors independently extracted data. Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines were used for data extraction and quality assessment. The primary outcomes were the rate of donor blood transfusion and change in hemoglobin level. The secondary outcomes included transfusion reaction, amniotic fluid embolism, and length of hospital stay. Results were summarized as weighted mean difference or risk ratio with associated 95% confidence intervals. Heterogeneity was measured using Higgins I2. RESULTS A total of 5 randomized controlled trials (n=3361) comparing cell salvage to standard care during cesarean delivery met the inclusion criteria. Primary analysis showed a significant decrease in receiving allogeneic blood transfusion with intraoperative cell salvage use vs standard care (odds ratio, 0.32; 95% confidence interval, 0.23-0.46), with no change in hemoglobin drop (mean difference, -0.77; 95% confidence interval, -1.67 to -0.14). The secondary outcomes showed no difference in transfusion reaction (odds ratio, 0.56; 95% confidence interval, 0.06-5.59), and length of hospital stay (mean difference, -1.90; 95% confidence interval, -4.85 to 1.06). No cases of amniotic fluid embolism were reported among the 1685 patients who received cell salvage. CONCLUSION Use of cell salvage during cesarean delivery reduced the overall need for allogeneic blood transfusion without increasing the risk of complications, including no cases of amniotic fluid embolism.
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Affiliation(s)
- Neel S Iyer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
| | - Kavisha Khanuja
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Amanda Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Huda B Al-Kouatly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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Postoperative Blood Salvage and Autotransfusion for Adult Spinal Deformity: A Randomized Controlled Trial. Spine (Phila Pa 1976) 2020; 45:1247-1252. [PMID: 31361726 DOI: 10.1097/brs.0000000000003176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE The aim of this study was to determine whether postoperative blood salvage and autotransfusion versus traditional closed suction drainage reduces the rate of homologous blood transfusions in patients undergoing surgery for adult spinal deformity. SUMMARY OF BACKGROUND DATA The use of intraoperative blood salvage has become commonplace in spine surgery; however, the collection and reinfusion of blood drained from the wound postoperatively have not been employed routinely because of increased cost and questionable benefit. METHODS Adult patients undergoing long posterior fusions were randomized to either a blood salvage and reinfusion system (OrthoPat - Group 1) or a standard subfascial closed suction drain (Group 2). Blood collected in Group 1 was reinfused according to the manufacturer's protocol. Reinfusion drains were converted to standard closed suction drains when output was <50 mL during 4 hours, and drains were removed when output was minimal. Patients received autologous or homologous blood transfusions when hemoglobin (Hg) <8 g/dL or they had symptomatic anemia. RESULTS Thirty-four patients were randomized into Group 1 and 36 patients into Group 2. There were no differences in preoperative or intraoperative parameters. Patients in Group 1 had higher hemoglobin levels on postoperative day (POD) 2 and POD 3 compared to those in Group 2. However, there was no significant difference in the percentage of patients requiring homologous blood transfusion between the two groups (41% Group 1 vs. 60% Group 2, P = 0.17). Similarly a subgroup analysis in patients with estimated blood loss >2000 mL also showed no difference in homologous blood transfusion rates (67% Group 1 vs. 76% Group 2, P = 0.58). There were no differences in the rate or type of postoperative complications. CONCLUSION Postoperative blood salvage and reinfusion result in a higher hemoglobin level in the early postoperative period, but does not significantly reduce the need for homologous blood transfusion. LEVEL OF EVIDENCE 1.
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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Miao Y, Guo W, An L, Fang W, Liu Y, Wang X, An L. Postoperative shed autologous blood reinfusion does not decrease the need for allogeneic blood transfusion in unilateral and bilateral total knee arthroplasty. PLoS One 2019; 14:e0219406. [PMID: 31283774 PMCID: PMC6613835 DOI: 10.1371/journal.pone.0219406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/21/2019] [Indexed: 01/28/2023] Open
Abstract
Postoperative shed autologous blood reinfusion techniques have been used for decades in total knee arthroplasty (TKA), but the effectiveness of this procedure is still a matter of debate. This multicenter retrospective study investigated the medical records of patients who underwent unilateral and bilateral TKA from January 1, 2015 to December 31, 2017 in three hospitals. According to whether postoperative shed autologous blood reinfusion was used, the patients were divided into the control group and the shed autologous blood reinfusion group. The volume of perioperative infusion of red blood cells and plasma, the blood transfusion-related costs, and the postoperative hospital stay were compared between the two groups of patients. A total of 200 unilateral and 74 bilateral TKA were included after successful matching. Among the patients who underwent unilateral TKA, the control group and the shed autologous blood reinfusion group had 95 and 91 patients, respectively, who received allogeneic blood infusion (P = 0.268). There was no significant difference in the number of units of allogeneic red blood cells infused (P = 0.154), while the transfusion-related cost was increased (P<0.001). The same phenomena were observed over the patients underwent bilateral TKA. Shed autologous blood reinfusion does not reduce the need for infusing allogeneic red blood cells. In addition, the procedure increases patient expense and may also lead to an extended postoperative hospital stay.
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Affiliation(s)
- YuLiang Miao
- Department of Anesthesiology, Chinese PLA No. 306 Hospital, Beijing, China
| | - WenZhi Guo
- Department of Anesthesiology, the seventh center of PLA general hospital, Beijing, China
| | - LiNa An
- Department of Anesthesiology, the third center of PLA general hospital, Beijing, China
| | - WeiWu Fang
- Department of Anesthesiology, Chinese PLA No. 306 Hospital, Beijing, China
| | - Yan Liu
- Department of Anesthesiology, Chinese PLA No. 306 Hospital, Beijing, China
| | - XiaoPing Wang
- Department of Orthopaedics, Chinese PLA No. 306 Hospital, Beijing, China
| | - LiKun An
- Department of Orthopaedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
- * E-mail:
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Zhang Y, Li D, Liu P, Wang X, Li M. Effects of different methods of using pneumatic tourniquet in patients undergoing total knee arthroplasty: a randomized control trial. Ir J Med Sci 2017; 186:953-959. [PMID: 28260153 DOI: 10.1007/s11845-017-1585-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The goal of this work was to investigate the effects of different methods of using pneumatic tourniquet on reducing blood loss in patients undergoing cemented total knee arthroplasty (TKA). METHODS One hundred and fifty patients undergoing unilateral cemented TKA were randomly divided into three groups (50 patients per group). The tourniquet was used during the entire operation (Group A), used from the beginning of operation to the completion of joint replacement (Group B), and from the beginning of osteotomy to the completion of arthroplasty (Group C). The following parameters were recorded: intraoperative blood loss (IBL), postoperative blood loss (PBL), hidden blood loss (HBL), and total blood loss (TBL); operation time and tourniquet time; incidence of postoperative complications; and hospital for special surgery (HSS) score. RESULTS IBL, HBL, and TBL in group C was significantly less than that in group B (all P < 0.05). Tourniquet time in group C was significantly less than that in groups A and B (all P < 0.05). The incidence of tourniquet-related complications in group C (6%) was relatively lower than that in group A (10%) during hospitalization (P > 0.05). Post-operative HSS scores at 2 weeks after the operation in group C was significantly higher than that in group A and group B (all P < 0.05). CONCLUSIONS Our results suggest that using a tourniquet from the beginning of osteotomy to the completion of arthroplasty could significantly reduce TBL in TKA, and decrease the incidence of complications; thereby facilitating early post-operative functional recovery.
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Affiliation(s)
- Y Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - D Li
- Department of Orthopedics, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Lixia District, Jinan, 250012, China.
| | - P Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - X Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Lixia District, Jinan, 250012, China
| | - M Li
- Department of Orthopedics, Qilu Hospital of Shandong University, No. 107 Wenhuaxi Road, Lixia District, Jinan, 250012, China.
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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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Rasouli MR, Maltenfort MG, Erkocak OF, Austin MS, Waters JH, Parvizi J. Blood management after total joint arthroplasty in the United States: 19-year trend analysis. Transfusion 2016; 56:1112-20. [DOI: 10.1111/trf.13518] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 12/14/2015] [Accepted: 12/25/2015] [Indexed: 12/28/2022]
Affiliation(s)
- Mohammad R. Rasouli
- Rothman Institute of Orthopedics; Thomas Jefferson University; Philadelphia Pennsylvania
- Sina Trauma and Surgery Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Mitchell G. Maltenfort
- Rothman Institute of Orthopedics; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Omer F. Erkocak
- Rothman Institute of Orthopedics; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Mathew S. Austin
- Rothman Institute of Orthopedics; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Jonathan H. Waters
- Department of Anesthesiology and Bioengineering; University of Pittsburgh Medical Center
- McGowan Institute for Regenerative Medicine; University of Pittsburgh; Pittsburgh Pennsylvania
| | - Javad Parvizi
- Rothman Institute of Orthopedics; Thomas Jefferson University; Philadelphia Pennsylvania
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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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The Reinfusion of Autogenous Shed Blood After Unilateral Total Knee Arthroplasty Using the Perioperative Autologous Transfusion System OrthoPAT. Am J Ther 2015; 23:e1623-e1629. [PMID: 26291592 DOI: 10.1097/mjt.0000000000000308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aims to explore the use of postoperative autogenous shed blood reinfusion using Orthopedic Perioperative Autotransfusion System (OrthoPAT) system in treating patients undergoing unilateral total knee arthroplasty (TKA). Fifty patients undergoing unilateral TKA were enrolled as the experimental group A and were treated with reinfusion of autologous shed blood within 6 hours after unilateral TKA using OrthoPAT. Accordingly, 50 patients undergoing unilateral TKA were selected as the experimental group B and were treated with allogeneic blood transfusion. Different indexes were observed at different times. Patients in both groups had relatively stable hemodynamics, and there was no postoperative coagulopathy. Prothrombin time, thrombin time, and activated partial thromboplastin time were lower, and fibrinogen was higher in group A than that in group B 24 hours after surgery (all P < 0.05). White blood cell, red blood cell, hemoglobin, hematocrit (Hct), and platelet count levels in group A were lower than those in group B 12 hours after surgery (all P < 0.05). The postoperative complications of the 2 groups have significant difference (P < 0.05). Postoperative autogenous shed blood reinfusion using OrthoPAT system in the treatment of patients undergoing unilateral TKA may improve the coagulation function of patients and reduce the rejection caused by standard allogeneic blood transfusion.
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10
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The increased total cost associated with post-operative drains in total hip and knee arthroplasty. J Arthroplasty 2014; 29:895-9. [PMID: 24360337 DOI: 10.1016/j.arth.2013.10.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 02/01/2023] Open
Abstract
In a consecutive series of 536 unilateral primary total hip arthroplasties (THAs) and 598 unilateral primary total knee arthroplasties (TKAs), the use of a post-operative drain was associated with $538 additional cost per THA, and $455 for TKA. The use of a drain increased hospital length of stay (LOS) for THA, but not for TKA. In both groups, the use of a drain increased estimated blood loss (EBL) and increased the amount of allogeneic blood transfused. Over the 10-week period, drain use was associated with a total cost of $432,972 for our institution. Data from this study would favor a selective approach to the use of drains in primary joint arthroplasties.
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Voorn VMA, Marang-van de Mheen PJ, Wentink MM, So-Osman C, Vliet Vlieland TPM, Koopman-van Gemert AWMM, Nelissen RGHH, Van Bodegom-Vos L. Frequent use of blood-saving measures in elective orthopaedic surgery: a 2012 Dutch blood management survey. BMC Musculoskelet Disord 2013; 14:230. [PMID: 23915322 PMCID: PMC3750265 DOI: 10.1186/1471-2474-14-230] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 07/30/2013] [Indexed: 12/03/2022] Open
Abstract
Background Blood loss in hip and knee arthroplasties may necessitate allogeneic blood transfusions. Different blood-saving measures (BSMs) were introduced to reduce these transfusions. Purpose of the present study was to assess the frequency of BSM use, stratified by type and hospital setting of orthopaedic departments in the Netherlands. Methods An internet-based questionnaire was sent to all heads of orthopaedic departments of Dutch hospitals and private clinics (n = 99). Questions were asked on how often BSMs were used, reported on a 5-point Likert scale (never, almost never, regularly, almost always, always). In addition there were questions about discontinuation of anticoagulants preoperatively, the number of annually performed arthroplasties (size) and hospital setting. Results The survey was completed by 81 (82%) departments. BSMs used frequently (regularly, almost always, always) were erythropoietine (EPO), with 55 (68%) departments being frequent users; acute normovolemic hemodilution, used frequently in 26 (32%) departments; cell saver in 25 (31%) and postoperative drainage and re-infusion in 56 (69%) departments. When compared by size, frequent EPO use was more common in large departments (with 22 (88%) large departments being frequent users versus 13 (63%) small departments and 16 (55%) intermediate departments, p = 0.03). No differences by size or type were observed for other BSMs. Conclusions Compared with previous survey’s there is a tremendous increase in use of BSMs. EPO and autologous blood salvage techniques are the most often used modalities. Costs might be saved if use of non-cost-effective BSMs is stopped.
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Affiliation(s)
- Veronique M A Voorn
- Department of Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, Leiden 2333, ZA the Netherlands
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Muñoz M, Campos A, Martín-Montañez E, Pavía J. Could cost-effectiveness of postoperative shed blood salvage after elective knee arthroplasty be improved? Transfusion 2013; 53:1372-3. [PMID: 23750931 DOI: 10.1111/trf.12154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Partridge J, Harari D, Gossage J, Dhesi J. Anaemia in the older surgical patient: a review of prevalence, causes, implications and management. J R Soc Med 2013; 106:269-77. [PMID: 23759887 DOI: 10.1177/0141076813479580] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This review provides the clinician with a summary of the causes, implications and potential treatments for the management of anaemia in the older surgical patient. The prevalence of anaemia increases with age and is frequently identified in older surgical patients. Anaemia is associated with increased postoperative morbidity and mortality. Allogenic blood transfusion is commonly used to treat anaemia but involves inherent risks and may worsen outcomes. Various strategies for the correction of pre- and postoperative anaemia have evolved. These include correction of nutritional deficiencies and the use of intravenous iron and erythropoesis stimulating therapy. Clear differences exist between the elective and emergency surgical populations and the translation of research findings into these individual clinical settings requires more work. This should lead to a standardized approach to the management of this frequently encountered clinical scenario.
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Konig G, Yazer MH, Waters JH. The effect of salvaged blood on coagulation function as measured by thromboelastography. Transfusion 2013; 53:1235-9. [PMID: 22934712 PMCID: PMC3521840 DOI: 10.1111/j.1537-2995.2012.03884.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is concern that salvaged blood has the potential to activate the coagulation system, which might place patients at risk of thrombotic complications. The aim of this study was to determine whether transfusion of salvaged blood after total knee arthroplasty (TKA) would lead to procoagulopathic changes as measured by thromboelastography (TEG) and furthermore if washing would reduce this risk. STUDY DESIGN AND METHODS Twenty-two patients undergoing TKA were enrolled. Control samples were venous blood samples taken before surgery. Test samples were created by mixing the control samples with postoperatively salvaged blood, either washed or unwashed. TEG profiles were measured, noting the time to initiate clotting (R), the time of clot formation (K), the angle of clot formation (α-angle), and the maximum amplitude (clot strength [MA]). RESULTS The changes in the coagulation profile from control samples to test samples were consistent for both the washed and the unwashed groups: R time decreased, MA decreased, and K and α-angle remained the same. However, the changes were more pronounced in the unwashed group than the washed group, with a 61% decrease in R time compared with 14%, and a 26% decrease in MA compared with 6%. CONCLUSION The addition of salvaged blood to the patient's preoperative blood resulted in decreased MA as well as decreased R time. This suggests that the reinfusion of postoperatively salvaged washed or unwashed blood after TKA favors a change toward a more hypocoagulable state, and washing appears to reduce this effect.
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Affiliation(s)
- Gerhardt Konig
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Blood management and transfusion strategies in 600 patients undergoing total joint arthroplasty: an analysis of pre-operative autologous blood donation. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:370-6. [PMID: 23736922 DOI: 10.2450/2013.0197-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 02/04/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Blood loss during total joint arthroplasty strongly influences the time to recover after surgery and the quality of the recovery. Blood conservation strategies such as pre-operative autologous blood donation and post-operative cell salvage are intended to avoid allogeneic blood transfusions and their associated risks. Although widely investigated, the real effectiveness of these alternative transfusion practices remains controversial. MATERIALS AND METHODS The surgery reports of 600 patients undergoing total joint arthroplasty (312 hip and 288 knee replacements) were retrospectively reviewed to assess transfusion needs and related blood management at our institute. Evaluation parameters included post-operative blood loss, haemoglobin concentration measured at different time points, ASA score, and blood transfusion strategies. RESULTS Autologous blood donation increased the odds of receiving a red blood cell transfusion. Reinfusion by a cell salvage system of post-operative shed blood was found to limit adverse effects in cases of severe post-operative blood loss. The peri-operative net decrease in haemoglobin concentration was higher in patients who had predeposited autologous blood than in those who had not. DISCUSSION The strengths of this study are the high number of cases and the standardised procedures, all operations having been performed by a single orthopaedic surgeon and a single anaesthesiologist. Our data suggest that a pre-operative autologous donation programme may often be useless, if not harmful. Conversely, the use of a cell salvage system may be effective in reducing the impact of blood transfusion on a patient's physiological status. Basal haemoglobin concentration emerged as a useful indicator of transfusion probability in total joint replacement procedures.
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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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Panteli M, Habeeb S, McRoberts J, Porteous MJ. Enhanced care for primary hip arthroplasty: factors affecting length of hospital stay. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:353-8. [PMID: 23443743 DOI: 10.1007/s00590-013-1188-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/04/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Enhanced care in joint replacement requires identification and correction of the causes of delay in discharge while ensuring practice remains safe. We conducted prospective studies of factors delaying discharge following hip replacement in 2006 and 2010. METHODS Daily data were twice collected prospectively in 100 consecutive unselected primary cemented THR, by an independent observer. Reasons for delays in discharge and variation from the patient pathway were identified and addressed. RESULTS The mean length of stay (LOS) in 2006 was 4.3 days and in 2010, 3.56 days (target for discharge 4 days). In 2006, 31 patients had a stay of more than 4 days, 17 due to inadequate physiotherapy provision, 10 for medical and 4 for other reasons. In 2010, 15 patients had a stay of more than 4 days, 1 patient had inadequate physiotherapy provision, in 7 cases discharge was delayed because of need for blood transfusion and 7 because of need for catheterisation. Women aged more than 70 with preoperative haemoglobin of <12 g/dL were at particularly high risk of requiring transfusion. Catheterisation was also identified as a factor causing significant increase in LOS. Patients going home in less than 4 days were more likely to have had their operation in the morning. CONCLUSION Patient LOS is multifactorial and can be reduced by regular review of the care pathway to effect incremental changes that have a significant impact on reducing stay.
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