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

Abstract

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...

The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis

“…Allogenic blood transfusion may be related to systemic complications such as anaphylactic reaction, immunological rejection, hemolytic reaction, infectious disease, and metabolic disorders prolonging the duration of hospitalization and causing serious social economic burden [ 5 ]. So it is crucial to minimize the bleeding and transfusion requirements for the patients undergoing TKA.…”

Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

“…Kim et al [4] reported that in the THA procedure, the blood loss ranged between 1000 and 2000 ml, and this increased the requirement of allogeneic blood transfusion. However, allogeneic blood transfusion might increase the risk of adverse effects, such as viral infection, immune response, cardiovascular dysfunction, added cost and even death [7][8][9][10][11][12][13]. Recently, the enhanced recovery after surgery protocol has been improved in THA, and the key to the improvement is the blood management [14][15][16].…”

Is the combined application of both drain-clamping and tranexamic acid superior to the single use of either application in patients with total-knee arthroplasty?

“…[ 2 – 4 ] Allogenic blood transfusion is associated with adverse events, such as hemolytic reactions, immunologic reactions, disease transmission, transfusion-related acute renal failure, and cardiovascular dysfunction, resulting in financial burdens and potentially life-threatening effects on patients. [ 5 – 7 ] To date, various strategies have been attempted to minimize blood loss, including drug intervention, autologous donation, and allogenic blood transfusion. [ 8 ] In addition, several methods for bleeding control have been successfully employed in an effort to reduce postoperative blood loss and transfusion, including drain-clamping, tranexamic acid (TXA) administration, and tourniquets, among others.…”