Post-operative auto-transfusion in total hip or knee arthroplasty: a meta-analysis of randomized controlled trials

Abstract

Background: Total hip or knee arthroplasty is an elective procedure that is usually accompanied by substantial blood loss, which may lead to acute anemia. As a result, almost half of total joint arthroplasty patients receive allogeneic blood transfusions (ABT). Many studies have shown that post-operative auto-transfusion (PAT) significantly reduces the need for ABT, but other studies have questioned the efficacy of this method.

Methods: The protocol for this trial and supporting CONSORT checklist are available as supporting information; see Checklist S1. To evaluate the efficacy of PAT, we conducted a Cochrane systematic review that combined all available data from randomized controlled trials. Data from the six included trials were pooled for analysis. We then calculated relative risks with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences with 95% CIs for continuous outcomes.

Findings and conclusion: To our knowledge, this is the first meta-analysis to compare the clinical results between PAT and a control in joint replacement patients. This meta-analysis has proven that the use of a PAT reinfusion system reduced significantly the demand for ABT, the number of patients who require ABT and the cost of hospitalization after total knee and hip arthroplasty. This study, together with other previously published data, suggests that PAT drains are beneficial. Larger, sufficiently powered studies are necessary to evaluate the presumed reduction in the incidence of infection as well as DVT after joint arthroplasty with the use of PAT.

Figure 1. The QUOROM diagram for review.

RCT, randomized controlled trial.

Figure 2. The RRs and 95% CIs for the number of patients requiring at least one unit of ABT among patients treated with vs. without PAT.

It indicated that RRs of patients requiring ABT in the PAT group was significantly lower than that in the control group.

Figure 3. The MDs and 95% CIs for units of RBC per transfused patient among patients treated with vs. without PAT.

The pooled result demonstrated that there was no significant difference of the ABT index between the PAT group and the control group.

Figure 4. The MDs and 95% CIs for the volume of blood loss among patients treated with vs. without PAT.

The result indicated significantly less volume of blood loss in the PAT group than in the control group.

Figure 5. The MDs and 95% CIs for the post-operative Hb level among patients treated with vs. without PAT.

It demonstrated that post-operative Hb was significantly higher in the PAT group than in the control group.

Figure 6. The RRs and 95% CIs for the incidence of febrile reaction among patients treated with vs. without PAT.

It indicated that the febrile reaction rate in the PAT group decreased significantly compared with the control group.

Figure 7. The RRs and 95% CIs for the incidence of infection among patients treated with vs. without PAT.

The result revealed no significant difference between the treatment groups.

Figure 8. The MDs and 95% CIs for the length of hospital stay among patients treated with vs. without PAT.

It demonstrated LOHS in the PAT patients was shorter than patients in the control group after surgery.