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Clinical and economical advantages with postoperative autologous blood reinfusion in TKA
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August 2013
Clinical and economical advantages with postoperative autologous blood reinfusion in TKA
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study
Int Orthop. 2007 Jun;31(3):303-8. Epub 2006 Jun 30Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
60 patients undergoing unilateral total knee arthroplasty (TKA) were randomized to receive one of two procedures. The intervention group received unwashed autologous blood reinfusion postoperatively, while the control group received a transfusion of homologous banked blood. Results demonstrated that the use of autologous blood reinfusion postoperatively produced greater economical and clinical benefits as compared to the use of homologous banked blood transfusions.
Publication Funding Details
+
Funding:
Not Reported
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
1/4
Randomization
3/4
Outcome Measurements
1/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Unilateral total knee arthroplasty (TKA) can result in substantial blood loss. It is important to limit allogenic blood transfusions (ABT) when undergoing surgery due to its associated potential disadvantages and risks. As a result, different methods have been proposed in order to avoid the use of ABT such as preoperative autologous blood donation, perioperative blood salvage and the use of drugs. This study aimed to examine the effectiveness of postoperative reinfusion of autologous blood compared to homologous banked blood transfusions in TKA.
What was the principal research question?
Is postoperative autologous blood reinfusion more cost-effective and clinically advantageous compared to intraoperative homologous banked blood transfusions in total knee arthroplasty, as evaluated 15 days after surgery?
Study Characteristics
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Population:
60 patients undergoing unilateral total knee replacements (Mean age: 69.7 years; 47 females, 13 males)
Intervention:
Reinfusion Group: Patients received the reinfusion system of unwashed salvaged autologous blood and supplementation with homologous blood transfusions when required. (n=30) (Mean age: 69.2 years; 24 female, 6 male)
Comparison:
Control Group: Patients were administered one unit of homologous banked blood transfusion delivered intraoperatively using standard suction drains. Additional postoperative homologous blood transfusions were given when required. (n=30) (Mean age: 70.2 years; 23 female, 7 male)
Outcomes:
Blood loss, units of homologous blood required by patients postoperatively, haemoglobin, haematocrit and platelet values were each recorded.
Methods:
RCT: Single-Centered
Time:
15 days (Evaluation at postoperative day 1, 5, and 15)
What were the important findings?
- The intervention group had 5 patients (16.6%) that required 9 units of homologous banked blood postoperatively (0.3 units/patient; average blood reinfused: 808 ml; range: 300-1750 ml).
- The control group had 10 patients (33.3%) that required 15 units of homologous banked blood postoperatively (1.5 units/patient; average blood loss: 564 ml; range: 350-1500 ml)
- No significant differences were seen in the haemoglobin and haematocrit values between the intervention and control groups (p>0.05)
- The intervention group additionally reported a 36% reduction in blood management costs.
What should I remember most?
The use of autologous blood reinfusion postoperatively was a more cost-effective and clinically advantageous procedure in total knee arthroplasty compared to intraoperative infusion with homologous banked blood.
How will this affect the care of my patients?
Patients may limit the risk of contracting transfusion-associated complications such as infection and fatality by avoiding the use of homologous bank blood and receiving reinfusion of unwashed autologous blood postoperatively instead. Further high-quality evidence with larger sample sizes is needed to support these findings.
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