Intraoperative cell salvage in revision hip surgery

Abstract

Allogenic blood is a finite resource, with associated risks. Previous studies show intraoperative cell salvage (ICS) can reduce allogenic transfusion rates in orthopaedic surgery. However, there are concerns regarding efficacy and cost-effectiveness of ICS. This study was carried out to review ICS use in revision hip arthroplasty.All patients who underwent ICS and re-infusion between 2008 and 2010 in the Southern General Hospital (SGH) were audited. The fall in haemoglobin (Hb), volume of blood re-infused and postoperative allogenic transfusion rates were recorded. This group was compared to a similar SGH cohort who underwent surgery by the same surgeons between 2006 and 2008, and a pre-2005 control group where no ICS was used.The proportion of patients receiving a postoperative allogenic transfusion fell by 55% in the 2008–2010 ICS cohort compared with the control, and by 40% compared with the previous ICS group. In both instances, there was a statistically significant (p < 0.001) reduction in mean units transfused per patient; in the 2008–2010 ICS cohort, a mean of 0.8 units was used per patient, while 1.4 were used in the 2006–2008 cohort. 3.5 units were used in the control group. There was no statistically significant difference in age or preoperative Hb between the groups, or in length of hospital stay.In this study, ICS has been shown to be effective in reducing rates and volume of postoperative allogenic transfusion in patients undergoing revision hip surgery at the SGH. However, further work is needed to establish the effect of changing anaesthetic technique on postoperative allogenic transfusion rates.

The impact of bowl size, program setup, and blood hematocrit on the performance of a discontinuous autotransfusion system

“…Autotransfusion has been one of the key elements in blood conservation during surgical procedures for many years . Various autotransfusion devices have been used with high efficiency, especially in cardiac and orthopedic surgery . These applications are evidence‐based and recommended by guidelines for blood conservation .…”

A recuperação intraoperatória de células sanguíneas é eficaz em cirurgias de quadril?

“…Autologous blood collection techniques have been the subject of discussion since their introduction, more than 30 years ago. 13 There are still doubts, however, about the efficiency and costs related to these techniques in some surgeries and the discrimination of their use. 13 14…”

“…Indications for SC use include anticipation of blood loss > 1000 mL, average of one or more allogeneic blood transfusion units in the postoperative period, religious refusals, low preoperative hemoglobin level, risk factors for bleeding or if more than 10% of patients require transfusion in that type of surgery. 13…”

“…Other reported contraindications are malignancy, presence of very small particles for filter and systemic infections with dissemination risk. 4 13…”

Ergebnisqualität in der Revisionsendoprothetik: Eine Analyse von Routinedaten mit dem Vergleich zur externen Qualitätssicherung

“…Für den Qualitätsindikator "Wundhämatom/Nachblutung" wurde ein ergänzender Parameter definiert, um mittels des erfassten Transfusionsbedarfs (OPS8-800.c*) den Qualitätsindikator weiter validieren zu können. Es wurde bei dieser Analyse angenommen, dass ein Transfusionsbedarf für eine Endoprothesenwechseloperation mit einer Gabe mehr als 5 Erythrozytenkonzentraten ein Adverse Event für den Indikator nahelegt [20]. Eine Analyse für den Transfusionsbedarf der ersten 5 Erythrozytenkonzentrate ist aufgrund fehlender Abbildung im OPS-Code nicht möglich.…”