Efficacy and safety of autotransfusion versus both suction drainage and no drainage in TKA .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(22):10 BMC Musculoskelet Disord. 2016 Aug 1;17:142Fifteen randomized controlled trials were included in this meta-analysis and systematic reviewing comparing the efficacy and safety of autologous blood transfusion systems to both closed suction drainage and no drain use. Results on allogenic blood transfusion rate demonstrated a significantly lower rate with the use of autologous blood transfusion systems compared to closed suction drainage, but not when compared to no drain use. Hemoglobin level, the length of stay, and wound infection rate were not significantly different between either the use of autologous blood transfusion systems and closed suction drainage, or autologous blood transfusion systems and no drainage.
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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?
One of the most debated topics in the perioperative management of patients undergoing total knee arthroplasty is blood conservation. More specifically, there is considerable debate about whether autologous blood transfusion drains - a relatively new, expensive technology - offer any significant difference in blood management than standard closed-suction drains or no drain at all. Despite the previous randomized controlled trials conducted on the topic, there is currently a lack of a comprehensive review to base clinical decisions upon.
¿Cuál era la pregunta principal de la investigación?
In total knee arthroplasty, is there any significant difference in efficacy and safety between autologous blood transfusion and either closed-suction drainage or no drainage?
- There was a significantly lower incidence of allogenic blood transfusions among autologous blood transfusion systems groups compared to closed suction drainage groups (10 studies; OR 0.28 [95%CI 0.14-0.55]; p=0.0002); the difference between autologous blood transfusion systems and no drainage groups was not significant (5 studies; OR 0.73 [95%CI 0.47-1.13]; p=0.16).
- In analyses of hemoglobin levels between 3-5 days postoperatively, no significant differences were observed between autologous blood transfusion systems versus closed suction drainage (3 studies; MD 0.25 [95%CI -0.06, 0.56]; p=0.12), or autologous blood transfusion systems versus no drainage (2 studies; MD 0.41 [95%CI -0.26, 1.09]; p=0.23).
- No significant difference was observed in the length of hospital stay in analyses of autologous blood transfusion systems versus closed suction drainage (3 studies; MD -0.96 [95%CI -2.09, 0.17]; p=0.10), or autologous blood transfusion systems versus no drainage (2 studies; MD 0.07 [95%CI -0.67, 0.81]; p=0.85).
- No significant difference was observed in the incidence of wound infection in analyses of autologous blood transfusion systems versus closed suction drainage (3 studies; OR 0.98 [95%CI 0.40-2.38]; p=0.97), or autologous blood transfusion systems versus no drainage (1 study; OR 1.01 [95%CI 0.06-16.27]; p=1.00).
¿Qué es lo que más debo recordar?
In total knee arthroplasty, autologous blood transfusion systems demonstrated a significantly lower requirement of allogenic transfusion when compared to groups managed with standard closed suction drainage, however, there was no significant difference when compared management without drainage. Postoperative hemoglobin levels, length of hospital stay, and the incidence of wound infection did not significantly differ when compared between autologous blood transfusion systems and closed suction drainage, or autologous blood transfusion systems and no drainage.
¿Cómo afectará esto al cuidado de mis pacientes?
The results of this study suggest that there may be an advantage to using autotransfusion systems over closed suction drains when considering allogenic transfusion rate, though similar efficacy and safety between these two options was observed in all other outcomes studied. Additionally, no significant difference in any outcome measure was observed for autotransfusion compared to no drain use. Therefore, the question becomes whether the autotransfusion systems should be considered for routine use in the absence of a significant advantage over simply not using a drain, given the added expense of using autotransfusion systems.
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