Autotransfusion in major orthopaedic surgery: experience with 1785 patients

Borghi, Battista; Pignotti, Elettra; Montebugnoli, M.; Bassi, A.; Corbascio, M; Simone, Nicola de; Elmar, K; Righi, U; Laguardia, A. M.; Bugamelli, S.; Cataldi, Fabio; Ranocchi, R.; Feoli, M A; Bombardini, Tonino; Gargioni, G; Franchini, A; Caroli, Guido

doi:10.1093/bja/79.5.662

Cited by 27 publications

(16 citation statements)

References 8 publications

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“…The goal of this retrospective study was to analyze the efficacy of autologous transfusion in primary total knee and total hip arthroplasty (TKA, THA). Borghi et al stated that the risk for intravenous blood substitution rises with age and the ASA-Score and depends on gender, with a higher risk for transfusion in female patients [9]. In contrast, in the current study, blood loss was significantly higher in male patients.…”

Section: Discussioncontrasting

confidence: 76%

“…Focusing on the results in patients undergoing TKA, blood loss was neither influenced by the patient's BMI nor by the ASA score in the current cohort. Previous studies found ASA score to be a contributing factor towards the necessity for blood transfusion [9,14]. In the current patient cohort male TKA patients had significantly higher amounts of blood loss and allogenic transfusions.…”

Section: Discussionmentioning

confidence: 64%

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Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty

Schneider

Kendoff

O’Loughlin

et al. 2014

THC

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BACKGROUND: Autologous transfusion has become a cost-efficient and useful option in the treatment of patients with high blood loss following major orthopaedic surgery. However, the effectiveness of autologous transfusion in total joint replacement remains controversial. OBJECTIVE: The current study analyzed the efficacy of autologous transfusion with washed shed blood (WSB) in primary total knee and total hip arthroplasty (TKA, THA). METHODS: Between January 2011 and December 2011, patients being treated with a primary TKA (n = 162) and/or THA (n = 227) and who met the inclusion criteria were recruited to the study in consecutive fashion. RESULTS: The patient age, BMI and ASA scores showed no statistically significant correlation to the degree of blood loss, quantity of autotransfusion necessary or Hb differential in TKA patients. The use of an autologous transfusion system in TKA and THA is not correlated statistically to a reduction in the amount of allogenic or autologous transfusion. CONCLUSIONS: The use of the autotransfusion system does not correlate significantly with the amount of allogenic transfusion in TKA and THA in the current authors' patient cohort. Age, BMI and ASA score appeared not to exert significant influence on the total amount of autotransfusion or Hb difference.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 64%

Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty

Schneider

Kendoff

O’Loughlin

et al. 2014

THC

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“…Borghi et al. 37 used this combination of autotransfusion methods in a prospective series of 1785 patients undergoing primary or revision arthroplasty of the knee or hip, and only 7.3% of patients received allogeneic blood transfusions.…”

Section: Effectiveness Of Perioperative Red Cell Salvagementioning

confidence: 99%

Red cell salvage in orthopedic surgery

Múñoz

Campos

Muñoz

et al. 2006

Transfus Alt Transfus Med

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SUMMARY The increasing number of surgical procedures has raised the demand for allogeneic blood to a level that often exceeds supply. Moreover, 10% of all transfusions are given in the orthopedic surgery setting, requiring the avoidance of liberal transfusion criteria to further reduce the risk of infection and other complications. As a result, a series of blood‐conservation measures have been developed. In this article, we review the use of autologous transfusion in orthopedic surgery, with a special focus on perioperative red cell salvage. From data reviewed, it can be concluded that perioperative salvage of blood, either intraoperative cell salvage or postoperative cell salvage, seems to be an excellent source of functional and viable red cells, without many of the transfusion‐related risks and with few side effects. The effectiveness of perioperative cell salvage to reduce exposure to allogeneic blood is greatly enhanced by the implementation of a restrictive transfusion protocol and the association with other blood‐sparing strategies [preoperative autologous blood donation (PABD), erythropoietin, intravenous iron], especially in anemic patients. Moreover, perioperative cell salvage may reduce the number of required PABD units or render PABD unnecessary. Finally, although formal cost‐effectiveness studies on perioperative cell salvage are lacking, based on current allogeneic blood transfusion costs, it is generally accepted that the equivalent of at least one unit of blood needs to be recovered for these techniques to be cost‐effective. Therefore, these procedures should be used on a case‐by‐case basis.

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“…Since 1990 a large database was recorded at our institution for quality control of an integrated auto-transfusion regimen, including information from nearly 3,000 patients undergoing major orthopedic surgery [5,6]. The database includes data on thromboembolic prophylaxis and symptomatic thromboembolic complications up to 30 days after surgery.…”

Section: Introductionmentioning

confidence: 99%

Thromboembolic complications after total hip replacement

Borghi

Casati

2002

International Orthopaedics (SICOT)

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We conducted a retrospective analysis of 1,640 consecutive patients undergoing total hip replacement between 1990 and 1997 under general anesthesia and receiving three different prophylactic regimens. The thromboembolic prophylaxis consisted of low-dose unfractioned heparin (UFH), low-molecular-weight heparin (LMWH), or indobufen (INDO). Postoperatively, occurrence of symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) was recorded during the first 30 days after surgery and at a routine follow-up visit. Symptomatic DVT was diagnosed in 16 patients (0.9%), while PE occurred in eight patients (0.5%). Patients receiving UFH showed a higher incidence of symptomatic DVT (3.6%) than those patients receiving either LMWH (1.3%) or INDO (0.3%), with an odds ratio for developing symptomatic DVT when receiving UFH versus other treatments of 6.05 (95% confidence intervals [CI 95% ]: 3.63-10.07) (P=0.001). On the other hand, the diagnosis of PE was more frequently seen in patients receiving cemented hip arthroplasty (2.4%) than in patients receiving uncemented hip arthroplasty (0.34%), with an odds ratio of 3.185 (CI 95% : 2.01-5.02)(P=0.05).Resume Nous avons conduit une analyse rétrospective de 1640 patients consécutifs opérés pour arthroplastie totale de la hanche entre 1990 et 1997, sous anesthésie générale, et recevant trois régimes différents de prophylaxie thromboembolique : soit héparine fractionnée à basse dose, soit héparine de bas poids moléculaire poids moléculaire soit indobufen. Après l'intervention une thrombose profonde symptomatique ou une embolie pulmonaire a été recherchée pendant les premiers 30 jours après la chirurgie, et à une visite habituelle de routine. La thrombose veineuse profonde symptomatique a été diagnostiquée chez 16 patients (0.9%), pendant que l'embolie pulmonaire s'est produite chez 8 patients (0.5%). Les patients qui recevaient de l'héparine fractionnée ont montré une plus haute fréquence de thrombose veineuse profonde symptomatique (3.6%) que ceux patients qui recevaient de l'héparine de bas poids molé-culaire (1.3%) ou de l' indobufen (0.3%), avec une majoration du risque de 6.05 ( intervalle de la confiance de 95% [CI95%]: 3.63-10.07) (P= 0.001). Le diagnostic d'embolie pulmonaire a été fait plus fréquemment chez les patients qui ont eu une arthroplastie cimentée (2.4%) que chez ceux patients qui ont eu une arthroplastie noncimenté (0.34%), avec une majoration du risque de 3.185 (CI95%: 2.01-5.02) (P=0.05).

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Autotransfusion in major orthopaedic surgery: experience with 1785 patients

Cited by 27 publications

References 8 publications

Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty

Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty

Red cell salvage in orthopedic surgery

Thromboembolic complications after total hip replacement

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