Cell Salvage in Hip and Knee Arthroplasty
| Autor: | Leti van Bodegom-Vos, Veronique M. A. Voorn, Cynthia So-Osman, Perla J Marang-van de Mheen, Rob G H H Nelissen, Albert Dahan, Thea P. M. Vliet Vlieland, Ankie W. M. M. Koopman-van Gemert, S. B. Vehmeijer |
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| Rok vydání: | 2015 |
| Předmět: |
musculoskeletal diseases
medicine.medical_specialty Blood transfusion Arthroplasty Replacement Hip medicine.medical_treatment Lower risk law.invention Randomized controlled trial law medicine Humans Orthopedics and Sports Medicine Arthroplasty Replacement Knee Randomized Controlled Trials as Topic Operative Blood Salvage business.industry General Medicine Evidence-based medicine musculoskeletal system Arthroplasty Confidence interval Surgery surgical procedures operative Meta-analysis Relative risk Erythrocyte Transfusion business |
| Zdroj: | Journal of Bone and Joint Surgery, 97A(12), 1012-1021 |
| ISSN: | 1535-1386 0021-9355 1012-1021 |
| DOI: | 10.2106/jbjs.n.00315 |
| Popis: | Background: Cell salvage is used to reduce allogeneic red blood-cell (RBC) transfusions in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We performed a meta-analysis to assess the effectiveness of cell salvage to reduce transfusions in THA and TKA separately, and to examine whether recent trials change the conclusions from previous meta-analyses. Methods: We searched MEDLINE through January 2013 for randomized clinical trials evaluating the effects of cell salvage in THA and TKA. Trial results were extracted using standardized forms and pooled using a random-effects model. Methodological quality of the trials was evaluated using the Cochrane Collaboration’s tool for risk-of-bias assessment. Results: Forty-three trials (5631 patients) were included. Overall, cell salvage reduced the exposure to allogeneic RBC transfusion in THA (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.51 to 0.85) and TKA (RR, 0.51; 95% CI, 0.39 to 0.68). However, trials published in 2010 to 2012, with a lower risk of bias, showed no significant effect of cell salvage in THA (RR, 0.82; 95% CI, 0.66 to 1.02) and TKA (RR, 0.91; 95% CI, 0.63 to 1.31), suggesting that the treatment policy regarding transfusion may have changed over time. Conclusions: Looking at all trials, cell salvage still significantly reduced the RBC exposure rate and the volume of RBCs transfused in both THA and TKA. However, in trials published more recently (2010 to 2012), cell salvage reduced neither the exposure rate nor the volume of RBCs transfused in THA and TKA, most likely explained by changes in blood transfusion management. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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