Comparison between autologous blood transfusion drainage and closed-suction drainage/no drainage in total knee arthroplasty: a meta-analysis

Hong, Kyung‐Won; Pan, Jianke; Luo, Minghui; Xu, Shaofa; Liu, Jun

doi:10.1186/s12891-016-0993-z

Cited by 8 publications

(12 citation statements)

References 35 publications

(83 reference statements)

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“…Although it is commonly believed that a suction drain, placed intra-articularly reduces the formation of a haemarthrosis and enhances rehabilitation, many studies have yielded controversial results regarding its use[ 165 - 169 ]. Senthil Kumar et al[ 170 ] in report that most of the post-operative blood loss occurs in the first few hours and especially in the first four hours.…”

Section: Post-operativementioning

confidence: 99%

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Themistoklis¹,

Vogiatzaki²,

Kazakos³

et al. 2017

WJO

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Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.

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Section: Post-operativementioning

confidence: 99%

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Themistoklis¹,

Vogiatzaki²,

Kazakos³

et al. 2017

WJO

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show abstract

“…As described above, the advantages and disadvantages of the use of drain for TKA are still controversial. Although recent meta-analyses failed to show effects of drain use on hospital stay 6) , some recent articles described that drain use was related to prolonged hospital stay 7 , 8) .…”

Section: Introductionmentioning

confidence: 99%

A Multivariate Analysis on the Effect of No Closed Suction Drain on the Length of Hospital Stay in Total Knee Arthroplasty

Nishitani

Kuriyama

Nakamura

et al. 2019

Knee Surg Relat Res

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PurposeDespite the long history of drain use in total knee arthroplasty (TKA), no drain has been gaining popularity. The purpose of this study was to investigate whether drainage is related to the length of hospital stay.Materials and MethodsA total of 166 consecutive unilateral TKAs performed on 135 patients with osteoarthritis were retrospectively reviewed. Closed suction drainage was used in 111 cases (67%). Length of hospital stay after surgery was recorded, and a multivariate linear regression analysis was performed to evaluate various variables (patient factors, surgical factors, and post-surgical factors) and to investigate whether drainage was an independent variable.ResultsHospital stay was shorter in no drain cases (21.7±4.8 days) than in drain cases (24.2±3.7 days, p<0.001). The multivariate analysis showed that older age (β=0.12, p=0.02), drain use (β=2.81, p=0.03), and occurrence of comorbidity (β=1.46, p=0.04) were the independent variables associated with the extended hospital stay. There was no difference in comorbidity between drain cases (39.6%) and no drain cases (27.2%, p=0.13).ConclusionsThe drain use, age, and occurrence of comorbidity were related to the length of hospital stay. TKA without drain is an effective procedure both medically and economically.

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“…Some reports suggested that shed autologous blood reinfusion could reduce the demand for allogeneic blood [4, 5]. Similar to this conclusion is the meta-analyses by Carless et al [13] and Hong et al [14], which included 18 studies that covered from 1991 to 2008 and 15 papers that spanned from 1991 to 2014, respectively. Both meta-analyses concluded that shed autologous blood reinfusion could significantly reduce the infusion rate and volume of allogeneic red blood cells.…”

Section: Discussionmentioning

confidence: 66%

Postoperative shed autologous blood reinfusion does not decrease the need for allogeneic blood transfusion in unilateral and bilateral total knee arthroplasty

Miao

Guo

An³

et al. 2019

PLoS ONE

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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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Comparison between autologous blood transfusion drainage and closed-suction drainage/no drainage in total knee arthroplasty: a meta-analysis

Cited by 8 publications

References 35 publications

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

A Multivariate Analysis on the Effect of No Closed Suction Drain on the Length of Hospital Stay in Total Knee Arthroplasty

Postoperative shed autologous blood reinfusion does not decrease the need for allogeneic blood transfusion in unilateral and bilateral total knee arthroplasty

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