Favourable results of a new intraoperative and postoperative filtered autologous blood re-transfusion system in total hip arthroplasty: a randomised controlled trial

Abstract

Purpose A new intraoperative filtered salvaged blood re-transfusion system has been developed for primary total hip arthroplasty (THA) that filters and re-transfuses the blood that is lost during THA. This system is intended to increase postoperative haemoglobin (Hb) levels, reduce perioperative net blood loss and reduce the need for allogeneic transfusions. It supposedly does not have the disadvantages of intraoperative cell-washing/separating re-transfusion systems, such as extensive procedure, high costs and need for specialised personnel. To re-transfuse as much as blood as possible, postoperatively drained blood was also re-transfused. Methods A randomised, controlled, blinded, single-centre trial was conducted in which 118 THA patients were randomised to an intraoperative autologous blood re-transfusion (ABT) filter system combined with a postoperative ABT filter unit or highvacuum closed-suction drainage. Results On average, 577 ml of blood was re-transfused in the ABT group: 323 ml collected intraoperatively and 254 ml collected postoperatively. Hb level was higher in the ABT vs the high-vacuum drainage group: 11.4 vs. 10.8 g/dl, p =0.02 on day one (primary endpoint) and 11.0 vs. 10.4 g/dl, p = 0.007 on day three. Total blood loss was less in the autotransfusion group: 1472 vs. 1678 ml, p =0.03. Allogeneic transfusions were needed in 3.6 % of patients in the ABT group and 6.5 % in the drainage group, p =0.68. Conclusion The use of a new intraoperative ABT filter system combined with a postoperative ABT unit resulted in higher postoperative Hb levels and less total blood loss compared with a high-vacuum drain following THA.

Postoperative autotransfusion drain after total hip arthroplasty: a meta-analysis of randomized controlled trials

“…Ten of the studies detailed the methods of randomization used16171821222627283132; however, two used inadequate randomization (one was randomized by month of birth22, and another was randomized by hospital number32), which led to categorization as “high risk”. Six studies described adequate allocation concealment161718212631. Only two studies described the blinding methods used: one performed double blinding of surgeons and assessors16, and another performed blinding of the study assessors26.…”

“…All thirteen studies16171821222627282930313233 reported the rate of allogenic transfusion; the data from these studies were pooled. The pooled results showed that PATD significantly reduced the rate of allogenic transfusion (RR = 0.56; 95% CI: 0.40 to 0.77; p = 0.0004; Fig.…”

“…Data regarding total blood loss were only available in two studies1626. No significant heterogeneity was found (p = 0.89, I 2  = 0%).…”

“…Six studies161721272830 reported the Hb levels on days 1–3 after surgery. Therefore, we performed subgroup meta-analyses to compare the Hb levels based on the date.…”

“…Such drainage devices collect postoperatively shed blood and then retransfuse the shed blood (washed or unwashed) to patients within 6 hours postoperatively. Previous studies have demonstrated that PATD significantly reduces the rate of allogenic transfusion and results in reduced blood loss1617181920. However, the use of the PATD remains controversial, and some studies have questioned its effectivenss2122232425.…”