Which patients are more likely to benefit from postoperative shed blood salvage after unilateral total knee replacement? An analysis of 581 consecutive procedures

Muñoz, M.; Kühlmorgen, B.; Ariza, Daniel; Haro, Enrique Sepúlveda; Marroquí, A. Juárez; Ramirez, Gemma

doi:10.1111/j.1423-0410.2006.00868.x

Cited by 30 publications

(27 citation statements)

References 26 publications

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“…Nearly the same extent of patients with febrile reactions was found in both groups (RRs, 0.88; 95% CIs, 0.46 to 1.67; P = 0.69) [40], [41]. Pooling these results with regard to the incidence of febrile reactions showed that adverse effects (chills and febricula) developed during PAT in some patients but less often than during ABT, which agreed with previous reports [18], [23], [25]. The exact mechanism underlying the higher rates of febrile episodes after ABT has yet to be determined, but it seems that this problem could be reduced by not using ABT [19].…”

Section: Discussionsupporting

confidence: 90%

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Post-Operative Auto-Transfusion in Total Hip or Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

Zhao

Jiang

et al. 2013

PLoS ONE

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BackgroundTotal hip or knee arthroplasty is an elective procedure that is usually accompanied by substantial blood loss, which may lead to acute anemia. As a result, almost half of total joint arthroplasty patients receive allogeneic blood transfusions (ABT). Many studies have shown that post-operative auto-transfusion (PAT) significantly reduces the need for ABT, but other studies have questioned the efficacy of this method.MethodsThe protocol for this trial and supporting CONSORT checklist are available as supporting information; see Checklist S1. To evaluate the efficacy of PAT, we conducted a Cochrane systematic review that combined all available data from randomized controlled trials. Data from the six included trials were pooled for analysis. We then calculated relative risks with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences with 95% CIs for continuous outcomes.Findings and ConclusionTo our knowledge, this is the first meta-analysis to compare the clinical results between PAT and a control in joint replacement patients. This meta-analysis has proven that the use of a PAT reinfusion system reduced significantly the demand for ABT, the number of patients who require ABT and the cost of hospitalization after total knee and hip arthroplasty. This study, together with other previously published data, suggests that PAT drains are beneficial. Larger, sufficiently powered studies are necessary to evaluate the presumed reduction in the incidence of infection as well as DVT after joint arthroplasty with the use of PAT.

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Section: Discussionsupporting

confidence: 90%

“…A lower rate of re-infusion may prevent febrile reactions. It has been suggested that this rise in temperature was a response to the surgical procedure itself [25]. Therefore, postoperative febrile reactions are generally seen in the context of major orthopedic surgery.…”

Section: Discussionmentioning

confidence: 99%

Post-Operative Auto-Transfusion in Total Hip or Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

Zhao

Jiang

et al. 2013

PLoS ONE

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“…Our results verified no reduction in the need for postoperative ABT by using OrthoPAT 1 as a retransfusion device for WSB. This is in contrast to some studies [7,11,20,22,24,34] reporting a decreased requirement for ABT with a lower risk of transfusionassociated complications and economic benefit using one of several autologous retransfusion devices (OrthoPAT . In contradiction to our data, del Trujillo et al postulated a lower ABT rate for patients undergoing THAs who were treated with the OrthoPAT 1 retransfusion device [7].…”

Section: Discussioncontrasting

confidence: 49%

Does Single Use of an Autologous Transfusion System in TKA Reduce the Need for Allogenic Blood?: A Prospective Randomized Trial

Cip

Widemschek

Benesch

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Mechanical autotransfusion systems for washed shed blood (WSB) were introduced to reduce the need for postoperative allogenic blood transfusions (ABTs). Although some authors have postulated decreased requirements for ABT by using autologous retransfusion devices, other trials, mostly evaluating retransfusion devices for unwashed shed blood (USB), verified a small or no benefit in reducing the need for postoperative ABT. Because of these contradictory findings it is still unclear whether autologous retransfusion systems for WSB can reduce transfusion requirements. Questions/purposes We therefore asked whether one such autologous transfusion system for WSB can reduce the requirements for postoperative ABT. Methods In a prospective, randomized, controlled study, we enrolled 151 patients undergoing TKA. In Group A (n = 76 patients), the autotransfusion system was used for a total of 6 hours (intraoperatively and postoperatively) and the WSB was retransfused after processing. In Control Group B (n = 75 patients), a regular drain without suction was used. We used signs of anemia and/or a hemoglobin value less than 8 g/dL as indications for transfusion. If necessary, we administered one or two units of allogenic blood. Results Twenty-three patients (33%) in Group A, who received an average of 283 mL (range, 160-406 mL) of salvaged blood, needed a mean of 2

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“…In contrast, there are also other studies describing the use of CATS as an option for reducing blood loss and post-operative ABT [21,32,[39][40][41][42]. del Trujillo et al described in a prospective study a benefit in primary THA analysing 108 patients with no difference between cemented and non-cemented techniques [39].…”

Section: Discussionmentioning

confidence: 85%

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

Hawi

Kendoff

Hessling

et al. 2014

International Orthopaedics (SICOT)

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Purpose The goal of this study was to analyse the efficacy of blood autotransfusion using a continuous autologous transfusion system in revisions of total hip arthroplasty (THA). We looked at whether administration of allogeneic blood units was reduced in these cases and if there is a difference between cemented and non-cemented revisions. Methods Between January 2011 and December 2011, patients being treated with revision THA were included (n=411). The following parameters were analysed: patient age, gender, weight (kg), height (cm), body mass index (BMI, kg/m 2 ), surgical diagnosis, treatment and American Society of Anesthesiologists (ASA) classification score. The difference between pre-and post-operative haemoglobin (Hb, g/dl), amount of peri-operative blood loss (ml), amount of retransfused washed shed blood and amount of allogeneic and/or autologous transfusion (ml) were recorded. Results In both the cemented and non-cemented revision THA groups, there was no significant difference between pre-and post-operative Hb with or without using an autotransfusion system. In 92 of 186 cemented cases using an autologous transfusion system (49.5 %) and 38 of 117 non-cemented cases using an autologous transfusion system (32.5 %), allogeneic blood transfusion (ABT) was required. Cemented procedures using an autologous transfusion system got significantly more ABTs than non-cemented procedures using an autologous transfusion system (p=0.0042, odds ratio=2.035).Conclusions Use of an autologous transfusion system did not reduce the amount of ABT in revision THA in the patient cohort reported here. In our opinion, general blood management is required before and during surgery to reduce administration of ABT.

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Which patients are more likely to benefit from postoperative shed blood salvage after unilateral total knee replacement? An analysis of 581 consecutive procedures

Cited by 30 publications

References 26 publications

Post-Operative Auto-Transfusion in Total Hip or Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

Post-Operative Auto-Transfusion in Total Hip or Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

Does Single Use of an Autologous Transfusion System in TKA Reduce the Need for Allogenic Blood?: A Prospective Randomized Trial

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

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