Massive Blood Loss during Graft Harvesting with the Reamer Irrigator-Aspirator

Nabergoj, Marko; Giotikas, D; KrkovicMatija,

doi:10.15406/mojor.2016.05.00166

Cited by 2 publications

(3 citation statements)

References 9 publications

(21 reference statements)

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“…Thirteen studies [ 18 , 42 , 43 , 45 , 47 , 48 , 50 , 55 – 60 ] reported blood loss in a total number of 336 performed procedures with the RIA system. Of these 13 studies, five studies [ 47 , 48 , 50 , 56 , 58 ] reported the volume of blood lost, which resulted in a mean of 803.29 ml per case. Furthermore, five out of the 13 studies reported a drop in hemoglobin, resulting in a mean of 3.74 g/dl.…”

Section: Resultsmentioning

confidence: 99%

“…Clinically significant blood loss during RIA system application, which is associated with continuous irrigation due to the abundant intramedullary blood supply, was first reported in smaller case series [ 18 , 58 ] and more recently confirmed in multiple larger studies [ 43 , 47 , 50 , 71 ]. In the present systematic literature review, a mean blood loss of 803.29 ml, a drop in hemoglobin of 3.74 mg/dl and required blood transfusion in 9.72% of patients were observed.…”

Section: Discussionmentioning

confidence: 99%

“…Patients at a high risk for anemia-associated comorbidities [ 72 ] may benefit from intraoperative auto-transfusion of the blood lost due to the RIA system. However, cell saver filter cannot handle the large volume of fluid [ 58 ] that is produced when using the RIA system. Therefore, transfusion risk should be discussed with patients, and the choice of the RIA system should be carefully considered in patients with anemia or bleeding risk [ 71 ].…”

Section: Discussionmentioning

confidence: 99%

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Complications associated using the reamer–irrigator –aspirator (RIA) system: a systematic review and meta-analysis

Laubach

Weimer

Bläsius

et al. 2022

Arch Orthop Trauma Surg

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Introduction Complications associated with the application of the Reamer–irrigator–Aspirator (RIA) system are described in the literature. However, to date a systematic review and meta-analysis to assess prevalence of complications associated with the use of the RIA system have not been conducted. Materials and methods The review is registered with PROSPERO (CRD42021269982). MEDLINE, the Web of Science Core Collection, and Embase were searched from the inception to 10 August 2021. The primary objective was to assess complications and blood loss associated with the use of the RIA system. Results Forty-seven studies involving 1834 procedures performed with the RIA system were finally included. A total of 105 complications were reported, with a pooled estimated overall prevalence of 1.7% with a 95% confidence interval (CI) of 0.40 to 3.60, with cortex perforation being the largest reported complication with a total of 34 incidences. A significant subgroup difference was observed (p = 0.02). In subgroup 1 (bone graft harvesting), complication prevalence was 1.4% (95% CI 0.2–3.4); in subgroup 2 (clearance intramedullary canal) it was 0.7% (95% CI 0.00–6.30) and in subgroup 3 (reaming with RIA system prior to nail fixation) 11.9% (95% CI 1.80–26.40). No statistically significant difference for tibia and femur as RIA system application site was observed (CI 0.69–4.19). In studies reporting blood loss, a mean volume of 803.29 ml, a mean drop of hemoglobin of 3.74 g/dl and a necessity of blood transfusion in 9.72% of the patients were observed. Conclusions The systematic review and meta-analysis demonstrate a low overall prevalence rate of complications associated with the RIA system. However, especially the risk of cortical perforation and the frequently reported relevant intraoperative blood loss are complications that should be anticipated in perioperative management and ultimately considered when using the RIA system.

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