Intraoperative cell salvage in revision hip arthroplasty.
Journal
The bone & joint journal
ISSN: 2049-4408
Titre abrégé: Bone Joint J
Pays: England
ID NLM: 101599229
Informations de publication
Date de publication:
01 Oct 2023
01 Oct 2023
Historique:
medline:
2
10
2023
pubmed:
1
10
2023
entrez:
30
9
2023
Statut:
epublish
Résumé
The aim of this study was to perform a systematic review of the evidence for the use of intraoperative cell salvage in patients undergoing revision hip arthroplasty, and specifically to analyze the available data in order to quantify any associated reduction in the use of allogenic blood transfusion, and the volume which is used. An electronic search of MEDLINE (PubMed), Embase, Scopus, and the Cochrane Library was completed from the date of their inception to 24 February 2022, using a search strategy and protocol created in conjunction with the PRISMA statement. Inclusion criteria were patients aged > 18 years who underwent revision hip arthroplasty when cell salvage was used. Studies in which pre-donated red blood cells were used were excluded. A meta-analysis was also performed using a random effects model with significance set at p = 0.05. Of the 283 studies which were identified, 11 were included in the systematic review, and nine in the meta-analysis. There was a significant difference (p < 0.001) in the proportion of patients requiring allogenic transfusion between groups, with an odds ratio of 0.331 (95% confidence interval (CI) 0.165 to 0.663) associated with the use of cell salvage. For a total of 561 patients undergoing revision hip arthroplasty who were treated with cell salvage, 247 (44.0%) required allogenic transfusion compared with 418 of 643 patients (65.0%) who were treated without cell salvage. For those treated with cell salvage, the mean volume of allogenic blood which was required was 1.95 units (390 ml) per patient (0.7 to 4.5 units), compared with 3.25 units (650 ml) per patient (1.2 to 7.0 units) in those treated without cell salvage. The mean difference of -1.91 units (95% CI -4.0 to 0.2) in the meta-analysis was also significant (p = 0.003). We found a a significant reduction in the need for allogenic blood transfusion when cell salvage was used in patients undergoing revision hip arthroplasty, supporting its routine use in these patients. Further research is required to determine whether this effect is associated with types of revision arthroplasty of differing complexity.
Identifiants
pubmed: 37777212
doi: 10.1302/0301-620X.105B10.BJJ-2023-0300.R1
pii: BJJ-2023-0300.R1
doi:
Types de publication
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1038-1044Informations de copyright
© 2023 The British Editorial Society of Bone & Joint Surgery.
Déclaration de conflit d'intérêts
J. R. Howell, M. J. Hubble, A. M. Kassam, S. L. Whitehouse, and M. J. Wilson report institutional payments from Stryker, unrelated to this study. J. R. Howell, M. J. Hubble, and M. J. Wilson also report personal royalties from Stryker, unrelated to this study. A. M. Kassam also reports teaching payments from Stryker, unrelated to this study. M. J. Wilson also reports travel, accommodation, and subsistence payments for teaching, and a patent from Stryker, all unrelated to this study, and is President-elect of the British Hip Society.
Références
Kuppurao L , Wee M . Perioperative cell salvage . Continuing Education in Anaesthesia Critical Care & Pain . 2010 ; 10 ( 4 ): 104 – 108 . 10.1093/bjaceaccp/mkq017
Carroll C , Young F . Intraoperative cell salvage . BJA Educ . 2021 ; 21 ( 3 ): 95 – 101 . 10.1016/j.bjae.2020.11.007 33664978
Klein AA , Bailey CR , Charlton A , et al. Association of Anaesthetists: anaesthesia and peri-operative care for Jehovah’s Witnesses and patients who refuse blood . Anaesthesia . 2019 ; 74 ( 1 ): 74 – 82 . 10.1111/anae.14441 30270470
Behmanesh B , Gessler F , Adam E , et al. Efficacy of intraoperative blood salvage in cerebral aneurysm surgery . J Clin Med . 2021 ; 10 ( 24 ): 24 . 10.3390/jcm10245734 34945029
Côté CL , Yip AM , MacLeod JB , et al. Efficacy of intraoperative cell salvage in decreasing perioperative blood transfusion rates in first-time cardiac surgery patients: a retrospective study . Can J Surg . 2016 ; 59 ( 5 ): 330 – 336 . 10.1503/cjs.002216 27668331
Cheriyan J , Cheriyan T , Dua A , Goldstein JA , Errico TJ , Kumar V . Efficacy of intraoperative cell salvage in spine surgery: a meta-analysis . J Neurosurg Spine . 2020 ; 2020 : 1 – 9 . 10.3171/2019.12.SPINE19920 32244219
Sullivan IJ , Ralph CJ . Obstetric intra-operative cell salvage: a review of an established cell salvage service with 1170 re-infused cases . Anaesthesia . 2019 ; 74 ( 8 ): 976 – 983 . 10.1111/anae.14630 30912123
Odak S , Raza A , Shah N , Clayson A . Clinical efficacy and cost effectiveness of intraoperative cell salvage in pelvic trauma surgery . Ann R Coll Surg Engl . 2013 ; 95 ( 5 ): 357 – 360 . 10.1308/003588413X13629960045715 23838500
Ashworth A , Klein AA . Cell salvage as part of a blood conservation strategy in anaesthesia . Br J Anaesth . 2010 ; 105 ( 4 ): 401 – 416 . 10.1093/bja/aeq244 20802228
Sharma S , Cooper H , Ivory JP . An audit on the blood transfusion requirements for revision hip arthroplasty . Ann R Coll Surg Engl . 2002 ; 84 ( 4 ): 269 – 272 . 10.1308/003588402320439720 12215032
Mahadevan D , Challand C , Keenan J . Revision total hip replacement: predictors of blood loss, transfusion requirements, and length of hospitalisation . J Orthop Traumatol . 2010 ; 11 ( 3 ): 159 – 165 . 10.1007/s10195-010-0105-z 20835744
Jans Ø , Kehlet H , Hussain Z , Johansson PI . Transfusion practice in hip arthroplasty--a nationwide study . Vox Sang . 2011 ; 100 ( 4 ): 374 – 380 . 10.1111/j.1423-0410.2010.01428.x 21029109
Burnett RA , Bedard NA , DeMik DE , Gao Y , Liu SS , Callaghan JJ . Recent trends in blood utilization after revision hip and knee arthroplasty . J Arthroplasty . 2017 ; 32 ( 12 ): 3693 – 3697 . 10.1016/j.arth.2017.08.038 28951054
Kim JL , Park JH , Han SB , Cho IY , Jang KM . Allogeneic blood transfusion is a significant risk factor for surgical-site infection following total hip and knee arthroplasty: A meta-analysis . J Arthroplasty . 2017 ; 32 ( 1 ): 320 – 325 . 10.1016/j.arth.2016.08.026 27682006
Kunz JV , Spies CD , Bichmann A , Sieg M , Mueller A . Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort study . PLoS One . 2020 ; 15 ( 2 ): e0229325 . 10.1371/journal.pone.0229325 32084207
Fowler AJ , Ahmad T , Phull MK , Allard S , Gillies MA , Pearse RM . Meta-analysis of the association between preoperative anaemia and mortality after surgery . Br J Surg . 2015 ; 102 ( 11 ): 1314 – 1324 . 10.1002/bjs.9861 26349842
Carless PA , Henry DA , Moxey AJ , O’Connell D , Brown T , Fergusson DA . Cell salvage for minimising perioperative allogeneic blood transfusion . Cochrane Database Syst Rev . 2010 ; 2010 ( 3 ): CD001888 . 10.1002/14651858.CD001888.pub3 20238316
Page MJ , McKenzie JE , Bossuyt PM , et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews . BMJ . 2021 ; 372 : n71 . 10.1136/bmj.n71 33782057
Hohenhaus AE. . Chapter 24 - Blood Transfusion and Blood Substitutes . In: Dibartola SP . Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice ( Third Edition ). St Louis, Missouri, USA : W.B. Saunders ; 2006 . p. 567 - 83 .
Waters JH , Dyga RM , Waters JFR , Yazer MH . The volume of returned red blood cells in a large blood salvage program: where does it all go? Transfusion . 2011 ; 51 ( 10 ): 2126 – 2132 . 10.1111/j.1537-2995.2011.03111.x 21985047
Berger MD , Gerber B , Arn K , Senn O , Schanz U , Stussi G . Significant reduction of red blood cell transfusion requirements by changing from a double-unit to a single-unit transfusion policy in patients receiving intensive chemotherapy or stem cell transplantation . Haematologica . 2012 ; 97 ( 1 ): 116 – 122 . 10.3324/haematol.2011.047035 21933858
Brecher ME , Monk T , Goodnough LT . A standardized method for calculating blood loss . Transfusion . 1997 ; 37 ( 10 ): 1070 – 1074 . 10.1046/j.1537-2995.1997.371098016448.x 9354828
Wells GA , Shea B , O’Connell D , et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses . 2013 . http://www.ohri.ca/Programs/clinical_epidemiology/oxford.asp ( date last accessed 24 July 2023 ).
Bridgens JP , Evans CR , Dobson PMS , Hamer AJ . Intraoperative red blood-cell salvage in revision hip surgery. A case-matched study . J Bone Joint Surg Am . 2007 ; 89-A ( 2 ): 270 – 275 . 10.2106/JBJS.F.00492 17272439
Clark CR , Spratt KF , Blondin M , Craig S , Fink L . Perioperative autotransfusion in total hip and knee arthroplasty . J Arthroplasty . 2006 ; 21 ( 1 ): 23 – 35 . 10.1016/j.arth.2005.01.021 16446182
Clement CR , Duthie R . Cell salvage Minimises perioperative Allogenic blood transfusion in revision total hip replacement surgery “[abstract]" . 10th Congress of the European Hip Society ; 2012 , Milan, Italy : Hip International .
Endresen GK , Spiechowicz J , Pahle JA , Espeland B . Intraoperative autotransfusion in reconstructive hip joint surgery of patients with rheumatoid arthritis and ankylosing spondylitis . Scand J Rheumatol . 1991 ; 20 ( 1 ): 28 – 35 . 10.3109/03009749109165919 1901423
Garvin KL , Feschuk CA , Sekundiak TD , Lyden ER . Blood salvage and allogenic transfusion needs in revision hip arthroplasty . Clin Orthop Relat Res . 2005 ; 441 : 205 – 209 . 10.1097/01.blo.0000192033.50316.bf 16331004
Herd JM , Joseph JJ , McGarvey M , et al. Intraoperative cell salvage in revision hip surgery . Ann Med Surg (Lond) . 2014 ; 3 ( 1 ): 8 – 12 . 10.1016/j.amsu.2013.11.001 25568779
McMurray MR , Birnbaum MA , Walter NE . Intraoperative autologous transfusion in primary and revision total hip arthroplasty . J Arthroplasty . 1990 ; 5 ( 1 ): 61 – 65 . 10.1016/s0883-5403(06)80011-2 2319250
Nworah E , Ralph C , Jakt L . Using perioperative cell salvage (PCS) for revision hip surgery reduces the risk of allogenic blood transfusion. Abstracts of the XXX Annual Scientific Meeting of the British Blood Transfusion Society. 2012. Harrogate, UK . Transfus Med . 2012 ; 22 Suppl 1 : 1 – 64 . 23009587
Palmer AJR , Lloyd TD , Gibbs VN , et al. The role of intra-operative cell salvage in patient blood management for revision hip arthroplasty: a prospective cohort study . Anaesthesia . 2020 ; 75 ( 4 ): 479 – 486 . 10.1111/anae.14989 32037522
Phillips SJ , Chavan R , Porter ML , et al. Does salvage and tranexamic acid reduce the need for blood transfusion in revision hip surgery? J Bone Joint Surg Br . 2006 ; 88-B ( 9 ): 1141 – 1142 . 10.1302/0301-620X.88B9.17605 16943461
Walsh TS , Palmer J , Watson D , et al. Multicentre cohort study of red blood cell use for revision hip arthroplasty and factors associated with greater risk of allogeneic blood transfusion . Br J Anaesth . 2012 ; 108 ( 1 ): 63 – 71 . 10.1093/bja/aer326 22037224
Gianakos AL , Saad BN , Haring R , et al. Tranexamic acid lowers transfusion requirements and hospital length of stay following revision total hip or knee arthroplasty . Patient Saf Surg . 2021 ; 15 ( 1 ): 21 . 10.1186/s13037-021-00295-5 33975621
CRASH-2 trial collaborators , Shakur H , Roberts I , et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial . Lancet . 2010 ; 376 ( 9734 ): 23 – 32 . 10.1016/S0140-6736(10)60835-5 20554319
No authors listed . National Institute for Health and Care Excellence (NICE . November 18 , 2015 . https://www.nice.org.uk/guidance/ng24 ( date last accessed 7 August 2023 ).