Transfusion after harvesting bone graft with RIA: Practice changes reduced transfusion rate by more than half.

Autor: Marchand LS; University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA. Electronic address: lucas.marchand@hsc.utah.edu., Kellam PJ; University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA., Dekeyser GJ; University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA., Haller JM; University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA., Rothberg DL; University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA., Higgins TF; University of Utah, Department of Orthopaedic Surgery, Salt Lake City, UT, USA.
Jazyk: angličtina
Zdroj: Injury [Injury] 2023 Jul; Vol. 54 (7), pp. 110797. Date of Electronic Publication: 2023 May 07.
DOI: 10.1016/j.injury.2023.05.028
Abstrakt: Introduction: The Reamer Irrigator Aspirator (RIA) is frequently used as a tool for bone graft harvesting procedures. The initial use of this instrument for bone grafting was met with significant blood loss and high transfusion rates. However, the RIA remains an excellent tool to obtain large volumes of viable autologous graft. The aim of this study was to investigate how changes in the technical use of the RIA may affect blood loss.
Materials and Methods: We conducted a retrospective chart review of all patients who underwent RIA bone graft harvest over a 12-year study period. The patients were divided into two cohorts based upon changes in the technique used to obtain autograft harvest with the RIA. The traditional cohort (2008-2012) connected the RIA to dilation and curettage suction and selected reamer size based on radiographic parameters. The modified cohort (2012-2020) connected the RIA to wall suction, used improved techniques for reamer head sizing, and more diligence was paid toward the time the RIA was suctioning in the canal. Demographic information, surgical details, pre- and post-operative hematocrit (HCT), transfusion rate, intra-operative blood loss, reported volume of graft harvested, and iatrogenic fracture were recorded.
Results: 201 patients were included in the study with 61 patients in the traditional and 140 patients in the modified cohorts respectively. The average age was 51 years (range: 18-97) with 107 (53%) males. There was no difference in the demographic data between the two cohorts. No difference was noted between the traditional and modified cohorts in terms of the amount of average graft harvested (54cc vs 51cc; p = 0.34) or major complications (1 vs 2; p = 0.91). However, when comparing the traditional versus modified cohorts the traditional group demonstrated a larger average blood loss (675cc vs 500cc; p=<0.01) and HCT drop (13.7 vs 9.5; p=<0.01) with a higher transfusion rate (44% vs 19%; p = 0.001).
Conclusion: This series demonstrated a significant improvement in blood loss and transfusion with modified techniques used to obtain autologous bone graft with the RIA. Importantly, these techniques do not appear to limit bone graft harvest yield and can therefore be efficiently implemented without limiting the utility of the RIA.
Competing Interests: Declaration of Competing Interest This study received no funding. The authors report no conflicts of interest specifically relevant to this study. Individual sources of potential conflict are as follows
(Copyright © 2023. Published by Elsevier Ltd.)
Databáze: MEDLINE
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