The results suggest cell salvage is efficacious in reducing the need for allogeneic red cell transfusion in adult elective cardiac and orthopaedic surgery. The use of cell salvage did not appear to impact adversely on clinical outcomes. However, the methodological quality of trials was poor. As the trials were unblinded and lacked adequate concealment of treatment allocation, transfusion practices may have been influenced by knowledge of the patients' treatment status potentially biasing the results in favour of cell salvage.
Effect of postoperative reinfusion systems on hemoglobin levels in primary total hip and total knee arthroplasties. A prospective randomized study.
A prospective randomized study was undertaken to quantify the effect of reinfusion of postoperative shed blood drainage on the hemoglobin levels in patients undergoing elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). One hundred eleven patients were enrolled between December 1990 and August 1991. There were 42 THAs and 69 TKAs. The study group consisted of 57 patients (35 TKAs and 22 THAs) who received a CBC ConstaVac (Stryker Surgical, Kalamazoo, MI) reinfusion system. The control group consisted of 54 patients (34 TKAs and 20 THAs) who received a ConstaVac collection unit. Postoperative drainage volumes were recorded for both groups. In addition, the volume of reinfused blood was recorded for the study group. Postoperative hemoglobins were recorded on postoperative days 1, 3, and 6, the latter reflecting the discharge hemoglobin level. All patients were encouraged to predeposit two units of autologous blood for both THAs and TKAs. This study showed no statistically significant difference in the postoperative hemoglobin levels between the study and control groups at anytime. Additionally, there was no statistically significant difference between hemoglobin levels and drainage volumes in both the THA and TKA study groups, compared to their respective control groups. The results of this study suggest that reinfusion units are not necessary in THAs and TKAs as a matter of routine use.