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Anesthesiology. 2014 Apr;120(4):852-60. doi: 10.1097/ALN.0000000000000135.

Patient blood management in elective total hip- and knee-replacement surgery (part 2): a randomized controlled trial on blood salvage as transfusion alternative using a restrictive transfusion policy in patients with a preoperative hemoglobin above 13 g/dl.

Author information

1
From the Department Center of Clinical Transfusion Research, Sanquin Blood Supply, Leiden, The Netherlands (C.S.-O., J.A.V.H., and A.B.); Department of Orthopedic Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands (R.G.H.H.N.); Department of Anaesthesiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands (A.W.M.M.K.-v.G.); Department of Anaesthesiology, Slotervaart Hospital, Amsterdam, The Netherlands (E.K.); Department of Orthopedic Surgery, Slotervaart Hospital, and VU University Medical Center, Amsterdam, The Netherlands (R.G.P.); Department of Orthopedic Surgery, Groene Hart Hospital, Gouda, The Netherlands (R.O.); Department of Medical Statistics and BioInformatics, LUMC, Leiden, The Netherlands (T.M.J.-W. and R.B.); Department of Medical Decision Making, LUMC, Leiden, The Netherlands (W.B.v.d.H.); and Department of Immunohaematology and Blood Transfusion Service, LUMC, Leiden, The Netherlands (A.B.).

Abstract

BACKGROUND:

Patient blood management is introduced as a new concept that involves the combined use of transfusion alternatives. In elective adult total hip- or knee-replacement surgery patients, the authors conducted a large randomized study on the integrated use of erythropoietin, cell saver, and/or postoperative drain reinfusion devices (DRAIN) to evaluate allogeneic erythrocyte use, while applying a restrictive transfusion threshold. Patients with a preoperative hemoglobin level greater than 13 g/dl were ineligible for erythropoietin and evaluated for the effect of autologous blood reinfusion.

METHODS:

Patients were randomized between autologous reinfusion by cell saver or DRAIN or no blood salvage device. Primary outcomes were mean intra- and postoperative erythrocyte use and proportion of transfused patients (transfusion rate). Secondary outcome was cost-effectiveness.

RESULTS:

In 1,759 evaluated total hip- and knee-replacement surgery patients, the mean erythrocyte use was 0.19 (SD, 0.9) erythrocyte units/patient in the autologous group (n = 1,061) and 0.22 (0.9) erythrocyte units/patient in the control group (n = 698) (P = 0.64). The transfusion rate was 7.7% in the autologous group compared with 8.3% in the control group (P = 0.19). No difference in erythrocyte use was found between cell saver and DRAIN groups. Costs were increased by €298 per patient (95% CI, 76 to 520).

CONCLUSION:

In patients with preoperative hemoglobin levels greater than 13 g/dl, autologous intra- and postoperative blood salvage devices were not effective as transfusion alternatives: use of these devices did not reduce erythrocyte use and increased costs.

PMID:
24434302
DOI:
10.1097/ALN.0000000000000135
[Indexed for MEDLINE]

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