Drain use in total knee arthroplasty is neither associated with a greater transfusion rate nor a longer hospital stay

Chen, Jerry; Lee, Wu Chean; Chan, Hiok Yang; Chang, Paul Chee Cheng; Lo, Ngai Nung; Yeo, Seng Jin

doi:10.1007/s00264-016-3239-7

Cited by 21 publications

(26 citation statements)

References 23 publications

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“…Our 30-day related readmission rates are similar to previous published rate in our institution, which is between 1.7% and 2.9% for primary unilateral TKR. 24 This is lower than the 30-day all-cause readmission rates in literature of 4.0%–5.5%, 41–43 because it only looks at readmission that is related to complications attributable to the surgery. Nevertheless, our readmission rates are similar to Schairer et al ’s 30-day surgical readmission rate of 2.4%, of which cellulitis and surgical site infection are the most common causes.…”

Section: Discussionmentioning

confidence: 83%

“…This result is similar to previous published LOS rates of primary unilateral TKA in our institution. 24 …”

Section: Resultsmentioning

confidence: 99%

“… 22 We do not have data on whether drains were placed by the surgeons during the surgery; however, a recent study done in the same institution showed that while drains were associated with a larger drop in Hb level and greater total blood loss, it did not significantly impact blood transfusion rate, LOS or 30-day readmission rates. 24 We also did not have data on the prevalence of the use of intraoperative tranexamic acid infiltration into the joint, administration of intravenous tranexamic acid by the anaesthesiologists, or use of leucodepleted blood products for transfusion. Non-leucodepleted blood has been postulated to reduce transfusion related immunomodulatory effects including mortality, 46 although clinical studies in cardiac surgery have not proven to be conclusive so far.…”

Section: Discussionmentioning

confidence: 99%

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Association between preoperative anaemia with length of hospital stay among patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study

et al. 2017

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ObjectivesStudies in western healthcare settings suggest that preoperative anaemia is associated with poor outcomes after elective orthopaedic surgery. We investigated the prevalence of preoperative anaemia among patients with primary unilateral total knee arthroplasty (TKA) in Singapore and its association with length of hospital stay (LOS), perioperative blood transfusion and hospital readmission rates.MethodsRetrospective cohort study performed in a tertiary academic medical centre in Singapore, involving patients who underwent primary unilateral TKA between January 2013 and June 2014. Demographics, comorbidities, preoperative haemoglobin (Hb) level, LOS and 30-day readmission data were collected. Anaemia was classified according to WHO definition. Prolonged LOS was defined as more than 6 days, which corresponds to >75th centile LOS of the data.ResultsWe analysed 2394 patients. The prevalence of anaemia was 23.7%. 403 patients (16.8%) had mild anaemia and 164 patients (6.8%) had moderate to severe anaemia. Overall mean LOS was 5.4±4.8 days. Based on multivariate logistic regression, preoperative anaemia significantly increased LOS (mild anaemia, adjusted OR (aOR) 1.71, p<0.001; moderate/severe anaemia, aOR 2.29, p<0.001). Similar effects were seen when preoperative anaemia was defined by Hb level below 13 g/dL, regardless of gender. Transfusion proportionately increased prolonged LOS (1 unit: aOR 2.12, p=0.006; 2 or more units: aOR 6.71, p<0.001). Repeat operation during hospital stay, previous cerebrovascular accidents, general anaesthesia and age >70 years were associated with prolonged LOS. Our 30-day related readmission rate was 1.7% (42) cases.ConclusionAnaemia is common among patients undergoing elective TKA in Singapore and is independently associated with prolonged LOS and increased perioperative blood transfusion. We suggest measures to correct anaemia prior to surgery, including the use of non-gender-based Hb cut-off for establishing diagnosis.

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Section: Discussionmentioning

confidence: 83%

“…This result is similar to previous published LOS rates of primary unilateral TKA in our institution. 24 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Association between preoperative anaemia with length of hospital stay among patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study

et al. 2017

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“…Removal of drain is also associated with pain or sometimes breakage of drain tube requiring surgical removal 3). The non-use of an indwelling vacuum drain, owing to a tamponade effect, can reduce total blood loss 4). But it may lead to hematoma formation, pain, bleeding into dressings, wound tension, and hence slow down rehabilitation progress 5).…”

mentioning

confidence: 99%

Role of Suction Drain after Knee Arthroplasty in the Tranexamic Acid Era: A Randomized Controlled Study

Maniar

Pradhan²,

Bhatnagar

et al. 2019

Clin Orthop Surg

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Background Postoperative suction drains are used after total knee arthroplasty to avoid intra-articular hematoma formation although they can increase blood loss due to a negative suction effect. The use of tranexamic acid to reduce blood loss may nullify this. The aim of this study was to compare outcomes in patients undergoing total knee arthroplasty with or without drains and to analyze whether the drain's diameter also has an impact. Methods This is a prospective randomized study of patients undergoing unilateral total knee arthroplasty performed by a single surgeon. The study population was divided into three groups (A, 10G drain; B, 12G drain; and C, no drain). Pain, blood loss, swelling, wound-related complications, functional outcomes and questionnaire-based outcomes were assessed postoperatively. Results Each group had 35 patients comparable in most demographic and pre- and intraoperative characteristics. During the first 6 hours postoperatively, opioid consumption was significantly higher when the drain was not used ( p = 0.036). At 3 months postoperatively, new Knee Society Score (NKSS) was highest with the use of 12G drain ( p = 0.018). However, NKSS at 1 year was comparable across the three groups. With the use of tranexamic acid, blood loss and incidence of soakage of dressing were unaffected by the presence or absence of a drain. The calf girth, suprapatellar girth, soakage of dressing and range of motion were comparable in all three groups. There was no incidence of surgical site infection or deep vein thrombosis. Conclusions Presence of a suction drain significantly reduces opioid consumption during the first 6 hours after total knee arthroplasty. Use of a drain made no difference to the functional outcome at 1 year postoperatively. With the use of tranexamic acid in total knee arthroplasty, the total blood loss and the requirement of blood transfusion were unaffected by the presence or absence of closed suction drainage or by the bore of the drain used. The clinical parameters such as swelling, range of motion, infection and deep vein thrombosis also remained the same.

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“…Microbiological monitoring is a promising way of prevention of infection in selected cases [4][5][6]. Some other studies show that in selected cases and protected environment surgery can be equally safe without the use of a tourniquet or of electric cautery [7,8].…”

mentioning

confidence: 99%

About Orthopaedic awards, drains, patients safety and outcomes

Scarlat¹

2019

International Orthopaedics (SICOT)

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Drain use in total knee arthroplasty is neither associated with a greater transfusion rate nor a longer hospital stay

Cited by 21 publications

References 23 publications

Association between preoperative anaemia with length of hospital stay among patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study

Association between preoperative anaemia with length of hospital stay among patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study

Role of Suction Drain after Knee Arthroplasty in the Tranexamic Acid Era: A Randomized Controlled Study

About Orthopaedic awards, drains, patients safety and outcomes

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