title: Autologous wound drains have no effect on allogeneic blood transfusions in primary total hip and knee replacement: a three-arm randomised trial.
abstract: We hypothesised there was no clinical value in using an autologous blood transfusion (ABT) drain in either primary total hip (THR) or total knee replacement (TKR) in terms of limiting allogeneic blood transfusions when a modern restrictive blood management regime was followed. A total of 575 patients (65.2% men), with a mean age of 68.9 years (36 to 94) were randomised in this three-arm study to no drainage (group A), or to wound drainage with an ABT drain for either six hours (group B) or 24 hours (group C). The primary outcome was the number of patients receiving allogeneic blood transfusion. Secondary outcomes were post-operative haemoglobin (Hb) levels, length of hospital stay and adverse events. This study identified only 41 transfused patients, with no significant difference in distribution between the three groups (p = 0.857). The mean pre-operative haemoglobin (Hb) value in the transfused group was 12.8 g/dL (9.8 to 15.5) versus 14.3 g/dL (10.6 to 18.0) in the non-transfused group (p < 0.001, 95% confidence interval: 1.08 to 1.86). Post-operatively, the median of re-transfused shed blood in patients with a THR was 280 mL (Interquartile range (IQR) 150 to 400) and in TKR patients 500 mL (IQR 350 to 650) (p < 0.001). ABT drains had no effect on the proportion of transfused patients in primary THR and TKR. The secondary outcomes were also comparable between groups.
authors.affiliation: Medical Center Haaglanden, Department of Orthopaedic Surgery , Lijnbaan 32, 2501 CK Den Haag, The Netherlands.
authors.forename: B J W
authors.initials: BJ
authors.lastname: Thomassen
authors.affiliation: Medical Center Haaglanden, Department of Orthopaedic Surgery , Lijnbaan 32, 2501 CK Den Haag, The Netherlands.
authors.forename: P H C
authors.initials: PH
authors.lastname: den Hollander
authors.affiliation: The Lange Land Hospital, Department of Orthopaedic Surgery, Toneellaan 1, 2725 NA Zoetermeer, The Netherlands.
authors.forename: H H
authors.initials: HH
authors.lastname: Kaptijn
authors.affiliation: Leiden University Medical Centre, Department of Orthopaedic Surgery, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
authors.forename: R G H H
authors.initials: RG
authors.lastname: Nelissen
authors.affiliation: Reinier de Graaf Groep, Department of Orthopaedic Surgery, Reinier de Graafweg 3-11, 2625: AD Delft, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Pilot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D001804:Blood Transfusion, Autologous / Q000379:methods; D016001:Confidence Intervals; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D007720:Knee Prosthesis; D016015:Logistic Models; D008297:Male; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000628:therapy*; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Autologous blood; Hip; Knee; Reinfusion