Clinical efficacy of postoperative autologous transfusion of filtered shed blood in hip and knee arthroplasty

Strümper, Danja; Weber, E. W. G.; Gielen-Wijffels, S.; Drumpt, R. van; Bulstra, Sjoerd K.; Slappendel, R.; Durieux, Marcel E.; Marcus, Marco A. E.

doi:10.1111/j.1537-2995.2004.03233.x

Cited by 78 publications

(86 citation statements)

References 27 publications

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“…Increased infection rates due to non-drained hematoma providing excellent culture medium [1,2] or drains acting as a conduit into the depth of the wound [3][4][5] as well as persistent oozing from the surgical incision or out of the drainage hole [1,6] are potential disadvantages of both, using or omitting drains. Additionally, using drains might increase needs for homologous blood transfusions or reduce them by postoperative re-transfusion of drained blood [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach

Kleinert

Werner

Mamisch-Saupe

et al. 2011

Arch Orthop Trauma Surg

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Introduction Wondering if the use of drains allowing retransfusion of shed blood as opposed to closed suction drains or no drains would improve quality of care to patients undergoing simple non-cemented primary total hip replacement (THR) using a direct anterior approach, a three-arm prospective randomized study was conducted. Method One hundred and twenty patients were prospectively randomized to receive no drain, closed suction drains or drains designed for re-transfusion of shed blood. Blood loss, VAS pain scores, thigh swelling, hematoma formation, number of dressings changed and hospital stay were compared and patients followed for 3 months. Results Drains did not have any significance on postoperative haemoglobin and haematocrit levels or homologous blood transfusion rates. Patients receiving homologous blood transfusions had too small drain volumes to benefit from re-transfusion and patients, who get drained fluid re-transfused, were far away from being in need of homologous blood transfusion. Omitting drains resulted in more thigh swelling accompanied with a tendency of slightly more pain during the first postoperative day but without effect on clinical and radiological outcome at 3 months. Earlier dry operation sites resulting in simplified wound care and shorter hospital stay was encountered when no drain was used. Conclusion The possibility to re-transfuse drained blood was not an argument for using drains and, accepting more thigh swelling, we stop to use drains in simple noncemented primary THR using the direct anterior approach.

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Section: Introductionmentioning

confidence: 99%

Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach

Kleinert

Werner

Mamisch-Saupe

et al. 2011

Arch Orthop Trauma Surg

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“…In their prospective empirical study, Strmper et al (16) stated that there were no differences between the Hb concentrations of patients who did or did not receive allogeneic blood transfusion. On the other hand, in terms of BMI, there was no correlation with blood loss in which allogeneic blood transfusion during TKA was not examined in that study (17).…”

Section: Discussionmentioning

confidence: 99%

Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

Bilgili

Erçin

Peker³

et al. 2014

Balkan Med J

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Blood loss and replacement during surgery is a controversial issue in major orthopaedic surgery such as Total Knee Arthroplasty (TKA). Allogeneic blood transfusion causes legal problems and concerns in terms of transmission of transfusion-related diseases. Therefore, cell saver systems (CSS) were developed to minimize the need for allogeneic blood transfusion. However, contradictory results have arisen from studies examining the use of CSS to reduce the need for allogeneic blood transfusion in primary TKA (1-3). Additionally, transfusion by CSS may also cause coagulation, infection and haemodynamic instability (4). The autologous blood should be used within 6 hours in order to prevent potential contamination and febrile reactions (5-7).This study investigated the effect of CSS use on levels of allogeneic blood transfusion in TKA patients and the associated costs. An attempt was also made to determine the factors predicting the need for allogeneic blood transfusion. MATERIAL AND METHODFollowing approval from the Ethics Committee of our hospital and having informed consent by all patients, patients undergoing unilateral, cemented TKA for primary knee osteoarthritis between January 2012 and June 2013 in our clinic were retrospectively evaluated. In Group 1, 37 patients were treated with a CSS, and in Group 2, 39 patients were given allogeneic blood transfusion. Simultaneous bilateral TKA cases, revision surgery and missing medical record cases were excluded from the study. Patients who had inflammatory arthritis, haematological disease, post-operatively developing myocardial Background: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Aims: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Study Design: Retrospective comparative study. Methods: Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. Results:No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05) and cost was higher in Group 1 (p<0.05). Conclusion: Cell saver systems do not decre...

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“…Strumper et al [22] in a study performed on 135 patients receiving transfusion of filtered shed blood after total knee arthroplasty determined that the number of patients receiving autologous blood transfusions was reduced overall from 35 percent (controls) to 22 percent (study). The decrease of the allogeneic transfusion requirement was most significant after total knee arthroplasty from 18 to 6 percent (P<0.001).…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study

Zacharopoulos

Apostolopoulos

Kyriakidis

2006

International Orthopaedics (SICOT)

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The purpose of our study was to determine the effectiveness of a postoperative autologous blood reinfusion system as an alternative to homologous, banked blood transfusions in total knee arthroplasty. We carried out a prospective randomised controlled study on 60 patients having unilateral total knee replacements. In all these patients, the same surgical team applied the same surgical technique, and all patients followed the same rehabilitation program. In 30 of these patients (group A), a reinfusion system of unwashed salvaged blood was applied, and they were supplemented postoperatively with banked blood transfusions when required. A control group of 30 patients (group B), in whom standard suction drains were used, received one unit of homologous banked blood transfusion intraoperatively and additional blood transfusions postoperatively when required. The administration of banked blood transfusion was determined by the haemoglobin value (<9 mg/dl) and/or clinical signs (blood pressure, pulse, etc.). The values of haemoglobin, haematocrit and platelets were recorded preoperatively and the first, fifth and 15th postoperative days, respectively. Five patients of group A required nine units of homologous blood (0.3 units/patient) postoperatively. Ten patients of group B required an additional 15 banked blood units postoperatively (in total 45 banked blood units for group B; 1.5 units/ patient). In the study group, the total homologous blood requirements were reduced by 80%, while the postoperative blood requirements were reduced by 50%. There was no significant difference in the postoperative haematocrit and haemoglobin values between the two groups. The cost of the blood management in the study group was reduced by 36%. The use of an autologous blood reinfusion system reduces highly effectively the demands of homologous banked blood transfusion in total knee arthroplasty.

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Clinical efficacy of postoperative autologous transfusion of filtered shed blood in hip and knee arthroplasty

Abstract: We conclude that the Bellovac ABT device reduces allogeneic blood transfusions in TKA and THA.

Cited by 78 publications

References 27 publications

Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach

Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach

Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study

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