A prospective randomized study, use of closed suction drainage after revision hip arthroplasty may lead to excessive blood loss

Abstract

Suction drainage after primary total hip arthroplasties (THA) offers no benefits. Revision hip arthroplasties (RHA) are more demanding procedures and associated with greater blood loss compared to primary cases. There is still a lack of literature regarding the application of drainage in RHA. A total of 40 patients who underwent RHA were included in this prospective study. Simple randomization with an allocation ratio 1:1 was performed. Primary outcomes: total blood loss, hemoglobin drop, joint hematoma size in USG, infection. Secondary outcomes: blood transfusion rate, soft tissue hematomas, C-reactive protein levels, Visual Analogue Scale before and on 3rd day after surgery, Harris Hip Score before and 6 weeks after surgery. An intention to treat analysis was performed, with a 2-year follow up. Statistically significant differences between groups was in blood loss: drainage 1559.78 ml, non-drainage 1058.27 ml, (p = 0.029) and hemoglobin level on 1st day after surgery: drainage 10.58 g/dl, non-drainage 11.61 g/dl (p = 0.0496). In terms of the other analyzed parameters, statistical differences were not found. Our study revealed that the use of suction drainage may lead to higher blood loss in the early postoperative period. Further studies are needed to evaluate our results.

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

“…A heterogeneous meta-analysis reported that compared with regular drainage, autotransfusion reduced the need for allogeneic transfusion following TKA and THA, but not when compared with autotransfusion with no drainage 507 . Postoperative closed-suction drainage was found to increase total blood loss and blood transfusion requirements in THA 508,509 and provided no benefit in revision THA, as postoperative blood loss, transfusion rate and length of hospital stay may be higher with its use 510,511 . A recent prospective controlled double-blind study demonstrated that drainage of surgical wounds following primary THA might cause an increased requirement for blood transfusion 512 .…”

“…507 Postoperative closed-suction drainage was found to increase total blood loss and blood transfusion requirements in THA 508,509 and provided no benefit in revision THA, as postoperative blood loss, transfusion rate and length of hospital stay may be higher with its use. 510,511 A recent prospective controlled double-blind study demonstrated that drainage of surgical wounds following primary THA might cause an increased requirement for blood transfusion. 512 A meta-analysis in posterior spinal surgery with limited quality of evidence revealed no significant differences regarding estimated blood loss between patients using closed-suction drainages.…”

Closed-Suction Draining After Revision Hip Arthroplasty Carries Risk of Higher Blood Loss Early After Surgery

“…In a recent study, however, researchers found that the use of suction drainage after RHA may lead to higher blood loss in the early postoperative period. (See Bartosz et al, 2022. )…”