Postoperative autologous blood transfusion drain or no drain in primary total hip arthroplasty? A randomised controlled trial.

Horstmann WG, Kuipers BM, Slappendel R, Castelein RM, Kollen BJ, Verheyen CC
Int Orthop 2012;36:2033-2039.
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Review by : M. Muñoz
NATA Review

The authors conducted a randomized controlled trial in which 100 hip arthroplasty (THA) patients were randomly allocated to the autologous blood transfusion of postoperative drainage (ABT system) or no drainage to ascertain which regimen is superior for reducing allogeneic blood transfusion and total blood loss. The authors found no differences in Hb levels on the first and third postoperative days, total blood loss, allogeneic transfusions, pain scores, HHS, SF-36 scores, length of hospital stay or adverse events. Therefore, they concluded that both strategies are equally effective regarding the examined outcome variables.

This paper corresponds indeed to Dr. Horstmann’s PhD Thesis (Chapter 8). In the Methods section of this chapter, it is stated that a standardized blood management protocol patients was implemented in both groups, including: 1) epoetin treatment (3 x 40,000 IU) for anemia correction in patients presenting with preoperative Hb < 13.1 g/dL (although this is not stated in the paper); 2) NSAIDs were changed to selective COX-2 inhibitors (meloxicam); 3) acenocoumarol or aspirin were stopped 3 or 7 days before surgery, respectively, thus reducing further the risk for high blood loss; and, finally, 4) allogeneic blood transfusions were administered in accordance to a predefined transfusion protocol. As a result, mean preoperative Hb levels (14 g/dL) and mean lowest postoperative Hb level (> 10 g/dL) were relatively high. Consequently, one might not expect a benefit from postoperative shed blood reinfusion in this patients population with a low risk for bleeding and of receiving an allogeneic blood transfusion, nor an improvement in postoperative quality of life scores. Thus, the data presented in the study by Horstmann et al., although solid and clear, are of limited value as they may not be extrapolated to THA patients who are not managed with such a blood conservation protocol. This limitation may be important for everyday clinical practice in other centers.

– Manuel Muñoz