Cell Salvage in Hip and Knee Arthroplasty

Bodegom‐Vos, Leti van; Voorn, Veronique M A; So‐Osman, Cynthia; Vlieland, Thea Vliet; Dahan, Albert; Gemert, Ankie Wmm Koopman-van; Vehmeijer, Stephan B W; Nelissen, Rob G H H; Mheen, Perla J Marang-van de

doi:10.2106/jbjs.n.00315

Cited by 45 publications

(23 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This substantiates that blood salvage and EPO are low-value care. Regarding blood salvage, this is in line with the literature, on which the current study is based [30, 33, 53]. Regarding the use of EPO it is striking to see that, although effective (but not cost-effective), the EPO reduction did not lead to more transfusions, lower postoperative Hb, or increased LoS.…”

Section: Discussionsupporting

confidence: 85%

“…Regarding the use of EPO it is striking to see that, although effective (but not cost-effective), the EPO reduction did not lead to more transfusions, lower postoperative Hb, or increased LoS. The ongoing trend that allogeneic transfusions occur less frequent in the past years, as is shown for instance in the meta-analysis of van Bodegom et al [30], might be an explanation for this, as the benefit of EPO becomes smaller if the number of transfusions decreases.…”

Section: Discussionmentioning

confidence: 99%

“…The indication to use the technique is determined by an orthopedic surgeon or anesthesiologist. However, a recent meta-analysis showed that, based on RCTs published between 2010 and 2012, blood salvage did not lead to a reduction in transfused patients or in the volume of transfused blood in THA and TKA [30]. Other literature showed that EPO was effective to reduce the number of transfused patients and the volume of transfused blood [31, 32], but the costs of EPO were so high that it was considered not cost-effective in THA and TKA [29, 31–35].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The effectiveness of a de-implementation strategy to reduce low-value blood management techniques in primary hip and knee arthroplasty: a pragmatic cluster-randomized controlled trial

et al. 2017

Self Cite

View full text Add to dashboard Cite

BackgroundPerioperative autologous blood salvage and preoperative erythropoietin are not (cost) effective to reduce allogeneic transfusion in primary hip and knee arthroplasty, but are still used. This study aimed to evaluate the effectiveness of a theoretically informed multifaceted strategy to de-implement these low-value blood management techniques.MethodsTwenty-one Dutch hospitals participated in this pragmatic cluster-randomized trial. At baseline, data were gathered for 924 patients from 10 intervention and 1040 patients from 11 control hospitals undergoing hip or knee arthroplasty. The intervention included a multifaceted de-implementation strategy which consisted of interactive education, feedback on blood management performance, and a comparison with benchmark hospitals, aimed at orthopedic surgeons and anesthesiologists. After the intervention, data were gathered for 997 patients from the intervention and 1096 patients from the control hospitals. The randomization outcome was revealed after the baseline measurement. Primary outcomes were use of blood salvage and erythropoietin. Secondary outcomes included postoperative hemoglobin, length of stay, allogeneic transfusions, and use of local infiltration analgesia (LIA) and tranexamic acid (TXA).ResultsThe use of blood salvage (OR 0.08, 95% CI 0.02 to 0.30) and erythropoietin (OR 0.30, 95% CI 0.09 to 0.97) reduced significantly over time, but did not differ between intervention and control hospitals (blood salvage OR 1.74 95% CI 0.27 to 11.39, erythropoietin OR 1.33, 95% CI 0.26 to 6.84). Postoperative hemoglobin levels were significantly higher (β 0.21, 95% CI 0.08 to 0.34) and length of stay shorter (β −0.36, 95% CI −0.64 to −0.09) in hospitals receiving the multifaceted strategy, compared with control hospitals and after adjustment for baseline. Transfusions did not differ between the intervention and control hospitals (OR 1.06, 95% CI 0.63 to 1.78). Both LIA (OR 0.0, 95% CI 0.0 to 0.0) and TXA (OR 0.3, 95% CI 0.2 to 0.5) were significantly associated with the reduction in blood salvage over time.ConclusionsBlood salvage and erythropoietin use reduced over time, but not differently between intervention and control hospitals. The reduction in blood salvage was associated with increased use of local infiltration analgesia and tranexamic acid, suggesting that de-implementation is assisted by the substitution of techniques. The reduction in blood salvage and erythropoietin did not lead to a deterioration in patient-related secondary outcomes.Trial registrationwww.trialregister.nl, NTR4044Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0601-0) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The effectiveness of a de-implementation strategy to reduce low-value blood management techniques in primary hip and knee arthroplasty: a pragmatic cluster-randomized controlled trial

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…Previous meta-analyses12202444 have investigated the efficacy and safety of cell salvage in THA. However, the strength of these meta-analyses was weakened by poor methodological quality or other limitations, and the conclusions were inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Postoperative autotransfusion drain after total hip arthroplasty: a meta-analysis of randomized controlled trials

Xie

Pan

Hong

et al. 2016

Sci Rep

View full text Add to dashboard Cite

The use of a postoperative autotransfusion drain (PATD) to reduce allogenic blood transfusions in total hip arthroplasty (THA) remains controversial. Therefore, we conducted a meta-analysis to evaluate the efficacy and safety of this technique. Randomized controlled trials (RCTs) were identified from PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Thirteen RCTs (1,424 participants) were included in our meta-analysis. The results showed that PATD reduced the rate of allogenic transfusions (RR = 0.56; 95% CI [0.40, 0.77]) and total blood loss (MD = −196.04; 95% CI [−311.01, −81.07]). Haemoglobin (Hb) levels were higher in the PATD group on postoperative day 1 (MD = 0.28; 95% CI [0.06, 0.49]), but no significant differences on postoperative days 2 or 3 (MD = 0.29; 95% CI [−0.02, 0.60]; MD = 0.26; 95% CI [−0.04, 0.56]; respectively). There were no differences in length of hospital stay (MD = −0.18; 95% CI [−0.61, 0.25]), febrile reaction (RR = 1.26; 95% CI [0.95, 1.67]), infection (RR = 0.95; 95% CI [0.54, 1.65]), wound problems (RR = 1.07; 95% CI [0.87, 1.33]), or serious adverse events (RR = 0.59; 95% CI [0.10, 3.58]). Our findings suggest that PATD is effective in reducing the rate of allogenic transfusion. However, the included studies are inadequately powered to conclusively determine the safety of this technique.

show abstract

“…Cell saver is a reinjection technique in which the drained blood is filtered to remove hemolyzed cells, free hemoglobin and other impurities and washed for reinjection29,30). The use of cell saver protects patients and decreases the need for total RBC transfusions since the patient's own blood is being transfused by collecting intraoperative blood loss31).…”

Section: Strategy To Minimize Blood Lossmentioning

confidence: 99%

Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus

et al. 2017

View full text Add to dashboard Cite

The volume of hip arthroplasty is stiffly increasing because of excellent clinical outcomes, however it has not been shown to decrease the incidence of transfusions due to bleeding related to this surgery. This is an important consideration since there are concerns about the side effects and social costs of transfusions. First, anemia should be assessed at least 30 days before elective hip arthroplasty, and if the subject is diagnosed as having anemia, an additional examination of the cause of the anemia should be carried and steps taken to address the anemia. Available iron treatments for anemia take 7 to 10 days to facilitate erythropoiesis, and preoperative iron supplementation, either oral or intravenous, is recommended. When using oral supplements for iron storage, administer elemental iron 100 mg daily for 2 to 6 weeks before surgery, and calculate the dose using intravenous supplement. Tranexamic acid (TXA) is a synthetic derivative of the lysine component, which reduces blood loss by inhibiting fibrinolysis and clot degradation. TXA is known to be an effective agent for reducing postoperative bleeding and reducing the need for transfusions in primary and revision total hip arthroplasties. Patient blood management has improved the clinical outcome after hip arthroplasty through the introduction and research of various agents, thereby reducing the need for allogeneic blood transfusions and reducing the risk of transfusion-related infections and the duration of hospitalizations.

show abstract

Cell Salvage in Hip and Knee Arthroplasty

Cited by 45 publications

References 40 publications

The effectiveness of a de-implementation strategy to reduce low-value blood management techniques in primary hip and knee arthroplasty: a pragmatic cluster-randomized controlled trial

The effectiveness of a de-implementation strategy to reduce low-value blood management techniques in primary hip and knee arthroplasty: a pragmatic cluster-randomized controlled trial

Postoperative autotransfusion drain after total hip arthroplasty: a meta-analysis of randomized controlled trials

Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus

Contact Info

Product

Resources

About