Autologous blood transfusion drainage versus closed suction drainage following TKA .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2017;5(6):2 BMC Musculoskelet Disord. 2016 Nov 2;17(1):452Sixteen randomized controlled trials were included in this meta-analysis comparing autologous blood transfusion drainage and closed suction drainage following total knee arthroplasty. Results demonstrated a significantly lower incidence of allogeneic transfusion among groups treated with ABTD compared to CSD. No significant differences between drainage types were found in analyses of postoperative blood loss, postoperative hemoglobin levels, and complication rates.
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La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Postoperative blood management following total knee arthroplasty procedures is an important consideration for orthopaedic surgeons. Traditional methods of management include the use of closed suction drainage (CSD) to prevent the development of hematoma postoperatively, however, many have expressed concerns that the use of closed suction drains can increase blood loss compared to no drainage and can increase the need for allogeneic transfusion. To address this, autologous blood transfusion drainage (ABTD) has been developed. Despite several randomized controlled trials that have compared results between ABTD and CSD, inconsistent findings have been obtained. A meta-analysis was needed to better assess the comparative efficacy between ABTD and CSD in blood management following total knee arthroplasty.
¿Cuál era la pregunta principal de la investigación?
How does the efficacy and safety compare between autologous blood transfusion drainage and closed suction drainage in total knee arthroplasty?
- The incidence of allogeneic blood transfusion was significantly lower among ABTD groups (100/606) compared to CSD groups (242/597) (12 studies; OR 0.25 [95%CI 0.13-0.47]; p=0<0.0001, I-squared 77%). Assessment of funnel plot suggested the presence of publication bias.
- The mean number of transfused units was also significantly lower with ABTD compared to CSD (5 studies; MD -0.68/patient [95%CI -0.98, -0.39]; p<0.00001, I-squared 74%).
- No significant difference between ABTD and CSD groups was observed in the incidence of wound complications (3 studies; OR 0.98 [95%CI 0.40-2.38]; p=0.97, I-squared 0%) or the incidence of deep vein thrombosis (4/257 vs. 6/252; 4 studies; OR 0.69 [95%CI 0.21-2.24]; p=0.54, I-squared 0%).
- No significant difference was observed in the incidence of febrile complications between ABTD groups (50/244) and CSD groups (66/257) (6 studies; OR 0.78 [95%CI 0.25-2.40]; p=0.67, I-squared 56%).
- No significant difference between ABTD and CSD groups was observed in blood drainage volume (7 studies; MD -2.91mL [95%CI -43.50, 37.68]; p=0.89, I-squared 34%) or hemoglobin level between 5-8 days postoperatively (4 studies; MD 0.21g/dL [95%CI -0.07, 0.48]; p=0.14, I-squared 48%).
¿Qué es lo que más debo recordar?
In total knee arthroplasty, the use of autologous blood transfusion drainage led to a significantly lower rate of allogeneic blood transfusion when compared to closed suction drainage, though the presence publication bias could not be rejected. Otherwise, no significant differences between drainage types were observed in the incidences of wound complications, deep vein thrombosis, or febrile complications, nor postoperative blood loss volume.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this study suggest that autologous blood transfusion drainage systems may reduce the need for allogeneic blood transfusion when compared to closed suction drainage after total knee arthroplasty, while providing similar results regarding postoperative blood loss and complication rate. The result of this study, however, is limited by the suggestion of possible publication bias based on visual inspection of funnel plots. Additionally, many of the included studies featured small sample sizes; future trials should aim to enroll greater sample sizes to improve estimates of effect.
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