Abstract

Postoperative shed autologous blood reinfusion techniques have been used for decades in total knee arthroplasty (TKA), but the effectiveness of this procedure is still a matter of debate. This multicenter retrospective study investigated the medical records of patients who underwent unilateral and bilateral TKA from January 1, 2015 to December 31, 2017 in three hospitals. According to whether postoperative shed autologous blood reinfusion was used, the patients were divided into the control group and the shed autologous blood reinfusion group. The volume of perioperative infusion of red blood cells and plasma, the blood transfusion-related costs, and the postoperative hospital stay were compared between the two groups of patients. A total of 200 unilateral and 74 bilateral TKA were included after successful matching. Among the patients who underwent unilateral TKA, the control group and the shed autologous blood reinfusion group had 95 and 91 patients, respectively, who received allogeneic blood infusion (P = 0.268). There was no significant difference in the number of units of allogeneic red blood cells infused (P = 0.154), while the transfusion-related cost was increased (P<0.001). The same phenomena were observed over the patients underwent bilateral TKA. Shed autologous blood reinfusion does not reduce the need for infusing allogeneic red blood cells. In addition, the procedure increases patient expense and may also lead to an extended postoperative hospital stay.

Highlights

  • total knee arthroplasty (TKA) is currently an important method for the treatment of late and severe knee joint lesions

  • 86 patients were in the control group, and 72 patients were in the shed autologous blood reinfusion group

  • We investigated whether the use of shed autologous blood reinfusion equipment after unilateral or bilateral TKA can reduce the need for allogeneic red blood cell infusion and improve economic efficiency

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Summary

Methods

This multicenter retrospective study was approved by the Ethics Committees of the 306th Hospital of PLA in Beijing, General Hospital of Chinese People’s Armed Police Forces, and People’s Liberation Army General Hospital in Beijing. All providers follow the Beijing blood transfusion guidelines and use the same shed autologous blood reinfusion equipment. The orthopedic surgeon decided whether or not to use postoperative shed autologous blood reinfusion equipment without clear indications and tendencies. A drainage tube was placed on the surface of the prosthesis of each knee joint and was connected to a CBC II ConstaVac type electric negative pressure non-washing postoperative autologous blood collection and transfusion system (Stryker Inc.). The shed blood was collected into the anticoagulant-free vacuum canister connecting to a reinfusion bag, the shed blood was transfused through a 40-μm screen filter allowing the elimination of fat particles and other debris. The postoperative blood loss included autologous blood reinfusion or the drainage bag blood as well as the exudation absorption from the incision dressing; the sum of both was the total perioperative blood loss

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