Cost-effectiveness analysis of an autotransfusion program in primary knee and hip replacement surgery

OBJECTIVE: To evaluate the cost-effectiveness of a program for autotransfusion in patients undergoing primary prosthetic surgery of the knee and hip (cemented and non-cemented). MATERIAL AND METHODS: A case-control comparison. Retrospective group: review of case histories of patients undergoing surgery in 1993, screened to identify the subpopulation that would be candidates for a program of autotransfusion and to evaluate the blood transfusion policy. Prospective group: patients undergoing surgery between 1995 and 1996 who participated in an autotransfusion program. We studied the following variables in both groups: prevalence of exposure to homologous blood and the amount, perioperative course of hemoglobin/hematocrit, and mean cost of the blood treatment given. In the prospective group we examined agreement between autologous blood extracted before surgery and later reinfused. RESULTS: The prevalence of exposure to homologous blood fell significantly from the retrospective to the prospective phases as follows: knee surgery 43.8% to 11.6%, cemented hip replacement 75% to 17.4%, non-cemented hip replacement 73.5% to 15.2%. The amount of packed red cells from homologous blood also fell: knee surgery 0.9 +/- 1.1 units to 0.2 +/- 0.5 units, cemented hip replacement 1.4 +/- 1 to 0.3 +/- 0.6 units, non-cemented hip surgery 1.8 +/- 1.3 to 0.3 +/- 0.7 units. The most commonly used techniques were preoperative donation and postoperative blood salvage from drains. The mean direct costs of hemotherapy in the prospective phase (homologous + autologous) were greater than in the retrospective phase, with the highest costs incurred in cases using autotransfusion (preoperative donation + blood salvage). The least differences in cost were seen in preoperative donation, which was also associated with the lowest rate of reinfusion in knee surgery. CONCLUSIONS: The autotransfusion program described is effective for lowering and even preventing exposure to homologous blood. The efficacy of the program is adequate, though it could be improved. The costs related to autologous hemotherapy are greater when combined autotransfusion techniques are used. When only one technique is used, the best cost-benefit ratio comes with preoperative donation.     

Preoperative autologous blood donation with cardiac surgery

BACKGROUND: Preoperative autologous blood donation is commonly used to reduce exposure to homologous blood transfusions among patients undergoing elective cardiac surgery. The purpose of this study was to ascertain how much volume of predonated autologous blood need to avoid of homologous blood transfusion in cardiac procedure. METHODS: One hundred twenty-eight patients underwent scheduled cardiac procedure between January 1998 and December 1999. Group 1: 400 ml predonated, operation without cardiopulmonary bypass (CPB) [n = 33], group 2: 800 ml predonated, operation without CPB (n = 23), group 3: 800 ml predonated, operation with CPB (n = 36), group 4: 1,200 ml predonated, operation with CPB (n = 36). Surgical procedures underwent only off-pump coronary artery bypass grafting (OPCAB) in groups 1 and 2. In groups 3 and 4 included coronary artery bypass grafting (CABG), valve replacement, CABG + valve replacement and atrial septal defect repair. RESULTS: There were no significant differences in mean body weight, mean preoperative hematocrit values or mean volume of intraoperative blood loss between groups 1 and 2. There were no significant differences in mean age, mean body weight, mean preoperative and postoperative day-7 hematocrit values, mean volume of intraoperative blood loss or mean CPB time between groups 3 and 4. The mean postoperative day-7 hematocrit value was significantly lower in group 1 than in group 2. Homologous blood transfusion was avoided in 63.6% of those with predonation of group 1 versus 100% at group 2 (p < 0.05), 86.1% at group 3 versus 94.4% at group 4 (p < 0.05). In group 3, all patients who underwent redo operation or CABG + valve replacement needed homologous blood transfusion. CONCLUSIONS: Autologous blood transfusion is effective for reducing the homologous blood requirement. It also seems that predonation of 800 ml may be sufficient to avoid homologous blood transfusion in cardiac surgery, however predonation of 1,200 ml is desirable in cases of redo operation or CABG + valve replacement.     

Transfusion of previously deposited autologous blood for patients undergoing hip-replacement surgery

The efficacy of a program of transfusion of previously deposited autologous blood for patients undergoing total hip-replacement surgery was studied by comparing five different parameters for a group of fifty consecutive patients who deposited blood for autologous transfusion and a randomly chosen, closely matched control group of fifty patients who received only homologous blood. Sixty-two per cent of the patients in the group that deposited autologous blood did not receive additional homologous blood while in the hospital. The patients who deposited autologous blood had a mean preoperative hematocrit of 36 per cent, compared with 39 per cent for the control group, but the average postoperative hematocrits of the two groups did not differ (33 per cent). There was no significant difference in the average total loss of blood or need for replacement of blood between the groups. Transfusion-related complications developed in two patients in the control group. We concluded that previous deposit of autologous blood for transfusion is an effective method for reducing the need for transfusion of homologous blood and for avoiding the attendant complications of transfusion of homologous blood. This method of the replacement of blood should be considered for patients who are to undergo a major orthopaedic procedure on the hip.     

Postoperative blood salvage in total knee arthroplasty using the Solcotrans autotransfusion system

One hundred forty-four patients who underwent primary total knee arthroplasty were examined in a prospective controlled study to determine the efficacy and safety of a postoperative wound drainage autotransfusion system (Solcotrans, Smith & Nephew Richards, Memphis, TN). The patients were divided into two groups: control group 1 comprised 88 (61%) patients who either received a Hemovac disposable drainage system (63 patients) or the Solcotrans system and had inadequate drainage for autotransfusion (25 patients). Experimental group 2 comprised 56 (39%) patients who received a Solcotrans drainage system and were autotransfused. The Solcotrans proved itself safe. No sepsis, transfusion reactions, or coagulopathies were associated with autotransfusion, which averaged 524 mL. There were no significant differences between groups 1 and 2 when comparing preoperative and postoperative hemoglobins and hematocrits. The Solcotrans system did not lower homologous blood requirements. Only 1.6% (2 patients) of all patients who autodonated at least 2 units of autologous blood (122 patients) were in need of a homologous blood transfusion in the postoperative period. Thus, although safe, the Solcotrans system was not proven effective in the management of primary total knee arthroplasty patients.     

Scheduled autotransfusion in orthopedic surgery]

We report the results of a programmed autotransfusion protocol applied to 22 patients undergoing orthopedic surgery. The number of extractions depended on the surgical needs and on the scheduled time for surgery. Among the total amount of blood used in this study, 81.7% corresponded to the volume previously given by the patient. This volume was sufficient for autologous transfusion in 17 patients. The remaining 18.3% of volume corresponded to homologous blood. We compared the hematologic data obtained at the beginning of the protocol and at the immediate pre and postoperative phase. We found statistical differences among hemoglobin levels, hematocrit, mean corpuscular hemoglobin, and mean corpuscular volume. We conclude that programmed autotransfusion constitutes an ideal method to compensate blood losses during surgery. This method may be the future for hemotransfusion in programmed surgery.     

Intraoperative autologous blood transfusion for hemoperitoneum resulting from ectopic pregnancy or ovarian bleeding during laparoscopic surgery.

OBJECTIVE: Our purpose was to evaluate the efficacy and safety of intraoperative autologous blood transfusion during laparoscopic surgery for hemoperitoneum in benign gynecologic disease. METHODS: The Cell Saver, Haemo Lite 2, an intraoperative autologous blood salvage device, was used in laparoscopic surgery on 18 patients with ectopic pregnancies or ovarian bleeding who had a large hemoperitoneum with/without severe anemia and hypovolemic shock. RESULTS: The blood loss was 1186 +/- 789 mL, and the volume of reinfused processed blood was 661 +/- 405 mL in ectopic pregnancy cases. The blood loss was 716 +/- 219 mL, and the volume of reinfused processed blood was 496 +/- 138 mL in ovarian bleeding. Laparoscopic surgery was performed and homologous blood transfusion was not required in any patient. No adverse reactions or procedural difficulties associated with the autologous blood transfusions occurred. CONCLUSIONS: Intraoperative autologous blood transfusion enabled the performance of laparoscopic surgery for large hemoperitoneum caused by ectopic pregnancies or ovarian bleeding without a homologous blood transfusion.     

Autotransfusion after orthopedic surgery. Analysis of quality, safety and efficacy of salvaged shed blood

A series of immunosuppressant mechanisms can manifest during surgical procedures, mediated by immune system cells or by humoral factors, to which the immunosuppressant effects of anesthesia or blood transfusion may be added, possibly further prejudicing the patient's immunological status, having important clinical repercussions such as increased incidence of postoperative infection or tumor reappearance.Autotransfusion of various types is an effective alternative to homologous transfusion as the former avoids immunodepressant effects. Preoperative autotransfusion [preoperative donation of autologous blood (PTAB)] has been shown to be one of the safest and most effective techniques and is the gold standard for autotransfusion. Problems of over collection, anemia and over transfusion that sometimes occur with PTAB can be solved with better screening procedures. Intraoperative autotransfusion (IAT) and postoperative autotransfusion (PAT) avoid such problems completely. However, IAT is only cost-effective in certain procedures (bleeding > 1,000-1,500 mL) and is not applicable in others, such as knee arthroplasty. PAT, on the other hand, in addition to being a good complement to other autotransfusion methods, may be the technique of choice in some procedures, such as knee arthroplasty, particularly if PTAB is contraindicated or if it is logistically difficult for a hospital to provide.However, in spite of its demonstrated efficacy, PAT of filtered blood has many critics, who warn of possible side effects and recommend the use of washed blood, which would make the procedure enormously more expensive unless it is performed with the same equipment used for IAT. Therefore, this review will analyze the hematologic characteristics of filtered blood, including metabolic status and survival of red blood cells, the components of the hemostatic system and inflammatory mediators, the content of fat particles and the possibility of their clearance, the incidence of infections and the dissemination of tumor cells. This analysis can reach the conclusion that salvaged filtered blood is a source of red blood cells of sufficient quality to be safely reinfused and that their reinfusion contributes significantly to reduce the need for homologous blood.     

Should the Cell Saver Autotransfusion System Be Routinely Used in Elective Aortic Surgery?

The objective of this study is to identify the aortic surgery procedures in which the use of the Cell Saver autotransfusion system is beneficial in terms of the amount of autologous blood recovered and the reduction in blood bank demands. An evaluation of the cost-effectiveness of the system is also presented. Four hundred and thirty-four elective aortic interventions were retrospectively reviewed to examine the use of intraoperative autotransfusion (IAT). Evaluation was made of risk factors, preoperative hematological variables, the volume of IAT-processed reinfused blood, and homologous transfusion requirements over the period of hospitalization. The routine use of the IAT system was cost-effective in the interventions for AAA and TAA. In patients subjected to aortobifemoral bypass for aortoiliac occlusive disease, IAT served to alleviate demands on blood bank inventories, although in our center its use led to a slight increase in net cost. The routine use of IAT during unilateral revascularization due to occlusive disease offered no benefits in terms of reduced homologous transfusion requirements or cost-effectiveness.     

The results of intraoperative autotransfusion in orthopaedic surgery

Perioperative hemorrhage associated with major orthopaedic surgery can become life threatening. Homologous bank blood transfusion can replace the volume of blood lost but it has serious disadvantages such as the transmission of viral agents, it has an insufficient platelet count, and transfusion reactions are possible. Hypotensive anesthesia, predeposited autologous blood transfusion and intraoperative autotransfusion are used to reduce these disadvantages. This study evaluates the results of 700 patients who underwent major orthopaedic intervention in our clinic between June 1991 and April 1998. Ninety-nine patients had hip surgery while 601 patients had spinal surgery. The autotransfusion unit saved an average of 858.9 +/- 136.8 cc of blood and an average of 1.9 +/- 1.2 units of saved blood was transfused. None of these patients needed homologous blood transfusion. One hundred patients who had spinal surgery during the same period were used as a control group. The control group required an average of 3.2 +/- 2.1 units of bank blood. Preoperative and postoperative hematocrit values revealed a statistically significant difference between the autotransfusion group and the homologous transfusion group (p < 0.05). The results of this study suggest that intraoperative autotransfusion prevents the decrease in hematocrit values while reducing the need for bank blood transfusion and hence avoiding the risk of transmission of viral infections.     

Safety and efficacy of autologous blood donation before elective off-pump coronary artery bypass grafting

BACKGROUND: Preoperative autologous blood donation reduces exposure to homologous blood transfusions in cardiac surgery. The purpose of this study was to ascertain, how much volume of predonated autologous blood needed to avoid of homologous blood transfusion in scheduled off-pump coronary artery bypass grafting (OPCAB). METHOD: Fifty patients underwent scheduled OPCAB. These patients donated 400 ml (group A, n = 30) or 800 ml (group B, n = 20) of autologous blood before operation. These patients donated at a rate of 400 ml per week. All patients were given an equal volume of saline solution at the time of autologous donation. RESULT: There were no significant differences mean age, mean body weight, mean preoperative hematocrit values, mean graft number or mean volume of intraoperative blood loss between groups A and B. There was significant difference the mean postoperative day-7 hematocrit value (33.4 +/- 1.5% vs 38.7 +/- 1.5%, p < 0.05). The rates of avoiding homologous blood transfusion were 63.3% in group A and 100% in group B (p < 0.05). CONCLUSIONS: Autologous blood transfusion was effective for reducing the homologous blood requirement. We believe that 800 ml predonation is sufficient to avoid homologous blood transfusion in scheduled OPCAB, further patients with cardiovascular disease including severe coronary artery should be donated with the administration of saline.     

Autologous blood predeposit for elective surgery: a program for better use and conservation of blood

We report the results of a pilot study on predeposit autotransfusion for elective surgery. In 2 years 319 U, each consisting of 350 ml of blood, were donated by 206 patients. Each patient gave 1, 2, or 3 U according to hematocrit levels within 10 days of undergoing surgery on the gastrointestinal tract, lung, liver, kidney, brain, thyroid, arteries, or breast. A hemoglobin drop of about 0.8 gm/dl occurred after each blood donation. A total of 259 autologous and 128 homologous U were transfused to 166 patients during surgery or within postoperative day 4; 40 patients required no blood transfusion. About 70% of patients did not need homologous blood products in addition to autologous units. The most active team of surgeons and anesthesiologists covered about 40% of the patients' blood needs during the study period with autologous units. No patient experienced untoward reactions before, during, or after surgery. Surgeons' and anesthesiologists' responses to the program improved during the study as soon as the advantages of the procedure became clearer. However, gentle pressure from the Transfusion Center was essential for the program's expansion. The patients' acceptance was excellent. We conclude that predeposit autotransfusion is a safe and feasible procedure for transfusion treatment in elective surgery.     

Routine use of autotransfusion following cardiac surgery: experience in 700 patients.

An autotransfusion technique has been developed for collection and reinfusion of shed mediastinal blood. This system has been routinely applied in the postoperative management of 592 consecutive adult and 108 pediatric cardiac surgical patients. Two hundred seventy-one adult patients (46%) and thirty-six pediatric patients (33%) actually received autologous blood. Autotransfusion volume ranged from 50 to 21,350 ml per patient. In 1976 at our institution, homologous transfusion requirements averaged 8.4 +/- 0.7 units per adult patient. During 1978, with the routine use of postoperative autotransfusion, bank blood transfusions were lowered to 4.2 +/- 0.3 units per patient (p less than 0.001). In contrast to perioperative autotransfusion techniques, collection and reinfusion of shed mediastinal blood is particularly useful for intravascular volume replacement in patients with serious postoperative bleeding.     

Use of autologous blood in total hip replacement. A comprehensive program

We evaluated the effectiveness of a comprehensive program for the use of autologous blood in reduction of the need for transfusion of homologous blood in total hip replacement in a prospective study of a consecutive series of patients. Transfusion of homologous blood was minimized through transfusion of preoperatively deposited autologous blood, intraoperative and postoperative salvage of washed red blood cells, and use of the clinical condition of the patient as the sole criterion for transfusion of non-autologous blood, regardless of the hematocrit. The cases of 143 patients who had had 154 primary total hip replacements were studied. One hundred and forty-three procedures were done on patients who had not been prevented from donating blood for medical reasons, and 93 per cent of these 143 procedures were performed with the availability of one to five units of preoperatively deposited autologous blood. The patients predeposited an average of 2.6 units of blood for each procedure. Ninety-two per cent of the procedures for which autologous blood had been predeposited were performed without transfusion of homologous blood. In the entire group of patients, almost 90 per cent of the transfused blood was autologous blood. Intraoperative salvage of red blood cells was successful in 148 procedures, and salvage was continued in the recovery room for all of these patients. An average of 408 milliliters of red blood cells was saved and reinfused, and this was 28 per cent of the average total loss of blood (1435 milliliters) for this series of procedures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Autologous blood transfusion in total hip arthroplasty

PURPOSE: To determine the possibility of avoiding homologous blood transfusion during total hip arthroplasty, and to clarify the problems associated with autologous blood transfusion. METHODS: A total of 253 patients received autologous blood transfusion during total hip arthroplasty between April 1990 and December 2000. Patients were assessed for the volume of haemorrhage during surgery, possibility of avoidance of homologous blood transfusion, and the disposal of autologous blood. RESULTS: There were no significant differences in the mean volume of haemorrhage among different underlying diseases. The mean total volume of haemorrhage was 2039 (standard deviation, 992) ml in revision surgery and 1673 (717.3) ml in primary surgery (p<0.05). The rate of avoidance of homologous blood transfusion was 75% among patients who underwent primary surgery, and 61% among those who underwent revision surgery. The rate was 95% in cases in which a combination of preoperative blood pooling and intra-operative recovery was used, 49% in cases where the preoperative blood pooling system alone was used, and 42% in those in which the intra-operative recovery system alone was employed. The autologous blood had to be disposed of in 3 (1%) cases, all of which were revision procedures with replacement of the polyethylene liner alone. CONCLUSION: Combined use of the preoperative blood pooling and intra-operative recovery systems is effective for avoiding homologous blood transfusion.     

The effect of acute normovolemic hemodilution on homologous blood requirements and total estimated red blood cell volume lost

Background: Acute normovolemic hernodilution combined with retransfusion is one of the various techniques proposed to avoid homologous blood transfusion in cardiac surgery. The purpose of the present paper is to study the effect of the volume of autologous blood collected pre-cardiopulmonary bypass (CPB) on homologous blood requirements and total estimated red blood cell (RBC) volume lost in coronary artery bypass grafting (CABG) surgery.
Methods: Following induction of anesthesia, sequestration of one (5–8 ml/kg; Group I, n=14) or two units (12–15 ml/kg; Group 11, n=14) of fresh autologous blood was performed under electrocardiographic and hernodynamic control. Group III (n= 14) was designated as the control group. Autologous blood was reinfused at the conclusion of CPB.
Results: The use of homologous blood in the study groups was significantly less than in the control group. High-volume phlebotomy did not make a significant difference in the requirement of the homologous blood, while causing a mild increase in the total estimated RBC volume lost. No significant differences could be demonstrated in preoperative, post-CPB and discharge hematocrit levels and postoperative blood drainage between the groups.
Conclusion: Acute intraoperative hemodilution with high- and low-volume phlebotomy reduced the homologous blood requirements similarly regardless of the amount of phlebotomy.     

Autologous blood transfusion in patients with hepatocellular carcinoma undergoing hepatectomy

BACKGROUND: Homologous blood transfusion (HBT) has the risk of an immunosuppressive effect and may adversely affect the prognosis of patients with carcinomas. Autologous blood transfusion (ABT) has not yet become a standard procedure in gastroenteric cancer surgery. We investigated the usefulness and problems of ABT combined with the use of recombinant human erythropoietin (rh-EPO). METHODS: An evaluation of autologous blood transfusion (ABT) combined with recombinant human erythropoietin (rh-EPO) treatment was conducted in 46 patients with hepatocellular carcinoma undergoing hepatectomy. Preoperative autologous blood donation (ABD) was accomplished for 25 of the 46 patients. The preoperative changes in hemoglobin and hematocrit in relation to route of administration of erythropoietin were studied. In addition, intraoperative blood requirements and the postoperative complications for patients who predonated were compared with those of patients who underwent surgery without autologous predonation. RESULTS: The proportion of patients not requiring additional homologous blood transfusions (HBT) during operation was significantly higher in the ABD group than in the non-ABD group (88% versus 38%). The incidence of postoperative complications was significantly higher in patients receiving HBT than in nontransfused patients and in those receiving ABT. CONCLUSIONS: Preoperative autologous blood donation in combination with rh-EPO therapy markedly reduced the requirement for homologous blood transfusion during surgery in patients with hepatocellular carcinoma having hepatectomy.     

胸腰椎爆裂骨折前路手术中自体血回输

目的探讨术中自体血回输在胸腰椎爆裂骨折前路手术中的应用。方法87例胸腰椎爆裂骨折行前路减压植骨内固定术,采用术中自体血回输技术,观察自体血回输安全性。术中平均出血1180m L,收集红细胞液的压积为50%的自体血回输。结果术中平均回吸收红细胞压积50%自体血450m L,无输血反应及过敏反应发生,明显减少异体库血需要量。结论术中自体血回输在胸腰椎爆裂骨折前路手术中的应用是安全可靠的,有临床应用价值。     

A comparison of autologous transfusion procedures in hip surgery

The risks associated with transfusion can be minimized with autologous blood. The efficiency of preoperative deposit, preoperative hemodilution and intra- and postoperative autotransfusion in reducing homologous transfusions has been demonstrated. There seem to be few studies, however, that compared the different methods of autologous transfusion. This study was designed to evaluate the comparative efficiency of these methods. PATIENTS AND METHODS. Sixty-four patients scheduled for total hip arthroplasty were randomly divided into four groups: group I--preoperative autologous deposit: group II--preoperative hemodilution; group III--intra- and postoperative autotransfusion; group IV--control. Preoperative autologous donations were stored in CPDA-1 buffer. Three units of 450 ml were requested. A predonation hemoglobin (Hb) concentration of 11 g dl was required. Surgery was carried out in the 5th week after the first donation. Preoperative hemodilution to Hb 9 g/dl was carried out after induction of anesthesia and initial circulatory stabilization. A cell separator was used for intra- and postoperative autotransfusion. Postoperative autotransfusion of drainage blood was continued until 6 h after the beginning of the operation. Polygeline was used for volume resuscitation. If the Hb concentration fell below 9 g/dl in the operating room and intensive care unit or below 10 g/dl in the general ward, autologous blood or homologous packed red cells were transfused. Autologous blood collected with the cell separator was retransfused at the end of the operation and after the autotransfusion period irrespective of the actual Hb concentration. RESULTS. The general data of the patients, blood loss, and Hb concentration at the beginning of the study and postoperatively were comparable in the four groups. Homologous transfusion requirements amounted to 0 (0-1250) ml (median, range) packed red cells in group I (preoperative deposit). 500 (0-2000) ml in group II (hemodilution), 125 (0-1000) ml in group III (autotransfusion) and to 500 (0-1500) ml in group IV (control). In group I 14 of 16 patients, in group II 1 of 16, in group III 8 of 16 patients, in group IV 5 of 15 patients did not require homologous transfusion. The difference between group I and IV was significant (p = 0.004 and p = 0.003). Global coagulation tests, antithrombin III, and total serum protein were comparable in the four groups. DISCUSSION. The efficiency of preoperative hemodilution to reduce homologous transfusion requirements is limited]. In the present study, as in two other recent studies, hemodilution did not reduce homologous transfusion requirements. Autotransfusion with a cell separator can save approximately 50% of the erythrocytes lost during hip arthroplasty and 70% of the drainage loss. The homologous transfusion requirements for the autotransfused group reported here were less than in the control group; the difference, however, was not statistically significant. Patients participating in preoperative autologous deposit did not require homologous blood for hip arthroplasty in 62%-70% of cases in other investigations; in the present study 88% of the patients did not require homologous blood. CONCLUSION. Under the conditions studied, preoperative autologous deposit was the most efficient method of autologous transfusion for hip arthroplasty. It should be employed primarily.     

Preoperative autologous blood donation and intraoperative autotransfusion in first implantation of hip endoprostheses--a retrospective study]

The records of a total of 102 patients who underwent primary total hip replacement during 1987-88 were evaluated retrospectively. 36 patients had donated 1-3 units of whole blood preoperatively. Surgery was performed with the use of a device for intraoperative autotransfusion (IAT). Another 25 patients without preoperative autologous blood donation were operated with the use of IAT. None of these techniques was available for the remaining 41 patients. The mean perioperative blood loss and the mean volume of transfused blood were 1400 ml and 1000 ml respectively. Equal quantities of blood were lost intra- and postoperatively, whereas only one fifth of transfused blood was given intraoperatively. Homologous blood transfusion was not required in 32% of the patients for whom autologous blood was not available. However after preoperative autologous blood donation, 95% of the 2-unit donors and 100% of the 3-unit donors could be operated without homologous blood transfusion. Autologous blood donation did not increase the need for homologous blood transfusions. With the use of IAT it was only 20% of the patients that at least 500 ml of blood were salvaged for retransfusion. On the basis of these findings, elective primary total hip replacement would seem to be the ideal operation to be performed after preoperative autologous blood donation and, whenever possible with the use of IAT. The desirable ratio of 1,5:1 for the units of blood to be crossmatched preoperatively vs. units transfused perioperatively can be achieved solely by preoperative donation of 3 units of autologous blood.     

Postoperative drainage of knee arthroplasty is not necessary: A randomized study of 90 patients

We studied the management of postoperative drainage after total knee replacement (TKR). 90 primary total knee joint arthroplasties were prospectively randomized into 3 groups: a) no drain, b) an autotransfusion system, c) a standard disposable closed suction drainage system. We monitored hemoglobin and hematocrit values, drainage volume and transfusions (homologous and autologous), range of knee motion, knee swelling and hospital stay. Parameters were recorded preoperatively, days 0-8 and 4 months postoperatively. No significant differences were seen between the groups in any of the parameters measured. The results show no benefit from using postoperative drainage systems in knee arthroplasties. Savings of SEK 400 (USD 55) per patient would have resulted if drains had not been used at all.