Postoperative autologous blood transfusion drain or no drain in primary total hip arthroplasty? A randomised controlled trial

Horstmann, W; Kuipers, Bart M.; Slappendel, R.; Castelein, René M.; Kollen, Boudewijn J.; Verheyen, Cees C. P. M.

doi:10.1007/s00264-012-1613-7

Cited by 29 publications

(44 citation statements)

References 22 publications

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“…Concerns about patient safety and concerns to lose their own experience with the technique suggest that physicians strongly believe in the effectiveness of perioperative blood salvage. This is striking, as there is convincing evidence that shows no overall reduction of transfused patients using this technique 7,8,10‐14. As this study is part of a deimplementation project, these results indicate that a different approach needs to be taken for deimplementation of perioperative blood salvage versus EPO.…”

Section: Discussionmentioning

confidence: 87%

“…The study results of So‐Osman and coworkers are in line with recent literature. A number of recent trials that were not included in the currently available meta‐analyses show that perioperative blood salvage is not superior to a regular drain or no drain 10‐14. With respect to EPO, other studies also show that EPO is effective but that the costs are too high .…”

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confidence: 99%

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Perceived barriers among physicians for stopping non–cost‐effective blood‐saving measures in total hip and total knee arthroplasties

et al. 2014

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Background Despite evidence that the blood‐saving measures (BSMs) erythropoietin (EPO) and intra‐ and postoperative blood salvage are not (cost‐)effective in primary elective total hip and knee arthroplasties, they are used frequently in Dutch hospitals. This study aims to assess the impact of barriers associated with the intention of physicians to stop BSMs. Study Design and Methods A survey among 400 orthopedic surgeons and 400 anesthesiologists within the Netherlands was performed. Multivariate logistic regression was used to identify barriers associated with intention to stop BSMs. Results A total of 153 (40%) orthopedic surgeons and 100 (27%) anesthesiologists responded. Of all responders 67% used EPO, perioperative blood salvage, or a combination. After reading the evidence on non–cost‐effective BSMs, 50% of respondents intended to stop EPO and 53% to stop perioperative blood salvage. In general, barriers perceived most frequently were lack of attention for blood management (90% of respondents), department priority to prevent transfusions (88%), and patient characteristics such as comorbidity (81%). Barriers significantly associated with intention to stop EPO were lack of interest to save money and the impact of other involved parties. Barriers significantly associated with intention to stop perioperative blood salvage were concerns about patient safety, lack of alternatives, losing experience with the technique, and lack of interest to save money. Conclusion Physicians experience barriers to stop using BSMs, related to their own technical skills, patient safety, current blood management policy, and lack of interest to save money. These barriers should be targeted in strategies to make BSM use cost‐effective.

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Section: Discussionmentioning

confidence: 87%

mentioning

confidence: 99%

Perceived barriers among physicians for stopping non–cost‐effective blood‐saving measures in total hip and total knee arthroplasties

et al. 2014

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“…In THA, the use of a postoperative ABT system only significantly reduced allogeneic blood transfusions in one study when compared with a closedsuction drainage system, but this was not so in another study, and not when compared with no drainage system [12,17,18]. One randomised controlled trial was published on the comparison of the same intra-and postoperative ABT system used in this study compared with no drain after primary THA.…”

Section: Discussionmentioning

confidence: 81%

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

Horstmann

Swierstra

Ohanis

et al. 2013

International Orthopaedics (SICOT)

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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.

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“…Specifically, there may be a deficit in haemoglobin concentration due to haemolysis in the re-infused blood (however, in the presence of low suction pressure devices, appreciable haemolysis has not been detected in a previous study focussed on hidden blood loss in total hip and knee surgery [7]). A randomised controlled blinded prospective study, analysing the potential benefit using an autologus blood transfusion system, detected no significant advantages (in post-operative haemoglobin levels, number of homologous blood transfusions, clinical outcomes) compared with patients that received no drain [10]. …”

Section: Discussionmentioning

confidence: 99%

Blood loss reduction in cementless total hip replacement with fibrin spray or bipolar sealer: a randomised controlled trial on ninety five patients

Falez

Meo

Panegrossi

et al. 2013

International Orthopaedics (SICOT)

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PurposeSeveral studies have investigated effectiveness of fibrin spray or bipolar sealer to control peri-operative bleeding and reduce the need for blood transfusion, but a direct comparison between the two methods has not been previously performed. We conducted a prospective randomised trial, with standard electrocautery as a control group.MethodsIn our investigation, 95 patients were randomised to one of three parallel groups receiving (1) 10 mL of topical fibrin spray before closure, (2) haemostasis with radiofrequency energy using a bipolar sealer, and (3) standard electrocautery. All patients and staff apart from the surgeons were blinded until data analysis was complete. Peri-operative blood loss has been calculated using a formula described by Ward and Gross (considering estimated patient blood volume, pre- and post-operative haemoglobin and haematocrit levels), with mention of eventual blood re-infusion or transfusion, at given intervals from surgery (6, 24, 48, 72 hours).ResultsMean blood loss was lower for both methods investigated, compared to the control group at every time interval considered, although differences were stronger for fibrin spray [Quixil]. Mean blood saving at the given intervals from surgery (6–24–48–72 hours) was respectively 96 ml, 129 ml, 296 ml, and 121 ml for bipolar sealer [Aquamantys] and 235 ml, 368 ml, 642 ml, and 490 ml for fibrin spray. These results are statistically significant (p = 0.05) for fibrin spray at every interval compared to control values, while a significance is detectable for bipolar sealer only at 48 hours after surgery.ConclusionsThe fibrin spray group had the best performance in terms of blood loss, significantly reduced in comparison with the control group and bipolar sealer group. Blood loss reduction for the bipolar sealer was remarkable only at 48 hours, compared with the control group. Blood loss reduction for fibrin spray was significant at every time interval considered. Differences between the two treatments investigated and the control group narrowed slightly at 72 hours, as an expression of spontaneous homeostasis. Notable is the fact that blood volume saved with fibrin spray at 24 and 48 hours is comparable to the volume of at least one blood unit. A cost-effectiveness analysis should be considered in term of expense, biological risks (related to blood transfusion or human-derived products use) and bleeding-related complications.

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Postoperative autologous blood transfusion drain or no drain in primary total hip arthroplasty? A randomised controlled trial

Cited by 29 publications

References 22 publications

Perceived barriers among physicians for stopping non–cost‐effective blood‐saving measures in total hip and total knee arthroplasties

Perceived barriers among physicians for stopping non–cost‐effective blood‐saving measures in total hip and total knee arthroplasties

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

Blood loss reduction in cementless total hip replacement with fibrin spray or bipolar sealer: a randomised controlled trial on ninety five patients

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