title: Utility and cost of low-vacuum reinfusion drains in patients undergoing surgery for subcapital hip fracture repair. A before and after cohort study.
abstract: BACKGROUND
  Postoperative blood loss may be a risk factor for allogeneic blood transfusion (ABT) in patients undergoing subcapital hip fracture (SHF) repair. We investigated the utility and costs of using a low-vacuum reinfusion drain (Bellovac ABT) within a blood management protocol for reducing ABT requirements in consecutive SHF.
  
  
  METHODS
  The blood management protocol consisted of the application of a restrictive transfusion trigger (Hb < 8 g/dl), the peri-operative administration of IV iron sucrose (3 × 200 mg/48 h) ± recombinant erythropoietin (1 × 40 000 IU sc) and the use of Bellovac ABT (Group 2, n = 117). An immediate previous SHF series managed without Bellovac ABT served as control (Group 1, n = 138).
  
  
  RESULTS
  Overall, 72 out of 255 (28%) received at least one ABT unit (2·1 ± 1·0 U/transfused patient) without differences between groups. However, in the subgroup of patients with admission Hb < 13 g/dl, the use of Bellovac ABT reduced postoperative ABT rates (16% vs. 46%, for groups 2 and 1, respectively; P = 0·001), although only 3 were reinfused, and was cost-saving. The use of Bellovac ABT also resulted in fewer wound bleeding complications, but there were no differences in Hb at postoperative days 7 and 30 between groups.
  
  
  CONCLUSIONS
  In SHF patients with admission Hb < 13 g/dl and managed with peri-operative IV iron ± recombinant erythropoietin plus restrictive transfusion indication, the use of Bellovac ABT was associated with reduced ABT requirements, without increasing postoperative complications, and cost-savings.
authors.affiliation: GIEMSA, Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Muñoz
authors.forename: D
authors.initials: D
authors.lastname: Iglesias
authors.forename: J A
authors.initials: JA
authors.lastname: Garcia-Erce
authors.forename: J
authors.initials: J
authors.lastname: Cuenca
authors.forename: A
authors.initials: A
authors.lastname: Herrera
authors.forename: E
authors.initials: E
authors.lastname: Martin-Montañez
authors.forename: J
authors.initials: J
authors.lastname: Pavia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000379:methods*; D015331:Cohort Studies; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D008297:Male; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D013396:Suction; D014618:Vacuum
chemical_list: D004921:Erythropoietin; C066317:ferryl iron; D007501:Iron
keywords: IV iron; allogeneic transfusion; low-vacuum reinfusion drain; recombinant human erythropoietin; subcapital hip fracture; transfusion protocol