The merits of cell salvage in arthroplasty surgery: an overview.
Arthroplasty entails considerable exposure to allogenic blood transfusion. Cell salvage with washing is a contemporary strategy that is not universally used despite considerable potential benefits. We searched Embase and Medline to determine if blood salvage with washing during primary and/or revision hip and knee arthroplasty results in lower rates of transfusion and postoperative complications. We included 10 studies in our analysis, which we rated according to Downs and Black criteria. With primary knee arthroplasty, there was a reduction in transfusion rate from 22% to 76% and a 48% reduction in transfusion volume (n = 887). With primary hip arthroplasty, there was a reduction from 69% to 73% in transfusion rate and a 31% reduction in transfusion volume (n = 239). There was a significant decrease in length of hospital stay (9.6 v. 13.6 d). Studies of revision arthroplasty reported a 31%-59% reduction in transfusion volume (n = 241). The available evidence demonstrates reduced exposure to allogenic blood with the use of salvage systems. Studies have been underpowered to detect differences in infection rates and other postoperative complications. Future cost analysis is warranted.
The Department of Surgery, Section of Orthopaedics, University of Calgary, Calgary, Alta.
Chris J
CJ
Dusik
The Department of Surgery, Section of Orthopaedics, University of Calgary, Calgary, Alta.
Carol
C
Hutchison
Department of Undergraduate Medical Education, University of Calgary, Calgary, Alta.
David
D
Langelier
D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D057725:Operative Blood Salvage; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome