Clinical and economical advantages with postoperative autologous blood reinfusion in TKA .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):87 Int Orthop. 2007 Jun;31(3):303-8. Epub 2006 Jun 3060 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.
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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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?
- 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.
De que é que me devo lembrar mais?
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.
Como é que isto afectará o tratamento dos meus doentes?
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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