ARTHROPLASTY
The efficacy and safety of autologous blood transfusion drainage in patients undergoing total knee arthroplasty: a meta-analysis of 16 randomized controlled trials
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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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Was the bias in the selection of studies avoided?
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Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
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Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
How does the efficacy and safety compare between autologous blood transfusion drainage and closed suction drainage in total knee arthroplasty?
重要な知見は？
- 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%).
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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