GIEMSA, Facultad de Medicina, School of Medicine, University of Málaga, Málaga, Spain.
Blood Transfus. 2013 Apr;11(2):260-71. doi: 10.2450/2012.0139-12. Epub 2012 Nov 7.
Requirements for allogeneic red cell transfusion after total knee arthroplasty are still high (20-50%), and salvage and reinfusion of unwashed, filtered post-operative shed blood is an established method for reducing transfusion requirements following this operation. We performed a cost analysis to ascertain whether this alternative is likely to be cost-effective.
Data from 1,093 consecutive primary total knee arthroplasties, managed with (reinfusion group, n=763) or without reinfusion of unwashed salvaged blood (control group, n=330), were retrospectively reviewed. The costs of low-vacuum drains, shed blood collection canisters (Bellovac ABT, Wellspect HealthCare and ConstaVac CBC II, Stryker), shed blood reinfusion, acquisition and transfusion of allogeneic red cell concentrate, haemoglobin measurements, and prolonged length of hospital stay were used for the blood management cost analysis.
Patients in the reinfusion group received 152±64 mL of red blood cells from postoperatively salvaged blood, without clinically relevant incidents, and showed a lower allogeneic transfusion rate (24.5% vs. 8.5%, for the control and reinfusion groups, respectively; p =0.001). There were no differences in post-operative infection rates. Patients receiving allogeneic transfusions stayed in hospital longer (+1.9 days [95% CI: 1.2 to 2.6]). As reinfusion of unwashed salvaged blood reduced the allogeneic transfusion rate, both reinfusion systems may provide net savings in different cost scenarios (€ 4.6 to € 106/patient for Bellovac ABT, and € -51.9 to € 49.9/patient for ConstaVac CBCII).
Return of unwashed salvaged blood after total knee arthroplasty seems to save costs in patients with pre-operative haemoglobin between 12 and 15 g/dL. It is not cost-saving in patients with a pre-operative haemoglobin >15 g/dL, whereas in those with a pre-operative haemoglobin <12 g/dL, although cost-saving, its efficacy could be increased by associating some other blood-saving method.
全膝关节置换术后异体红细胞输血的需求仍然很高（20-50%），回收和再输注未洗涤、过滤的术后失血是减少此类手术输血需求的一种既定方法。我们进行了一项成本分析，以确定这种替代方法是否具有成本效益。
回顾性分析了 1093 例连续的初次全膝关节置换术患者的数据，这些患者分为接受（再输注组，n=763）或不接受未洗涤回收失血（对照组，n=330）治疗。低真空引流、失血收集罐（Bellovac ABT、Wellspect HealthCare 和 ConstaVac CBC II、Stryker）、失血再输注、同种异体浓缩红细胞的获取和输注、血红蛋白测定以及住院时间延长的费用用于血液管理成本分析。
再输注组患者从术后回收的血液中输注了 152±64mL 的红细胞，未发生临床相关事件，异体输血率较低（24.5%比对照组的 8.5%，p=0.001）。术后感染率无差异。接受异体输血的患者住院时间延长（+1.9 天[95%CI：1.2 至 2.6]）。由于未洗涤回收失血减少了异体输血率，因此两种再输注系统在不同的成本情况下都可能提供净节省（Bellovac ABT 为每例患者 4.6 至 106 欧元，Constavac CBC II 为每例患者-51.9 至 49.9 欧元）。
全膝关节置换术后回收未洗涤的失血似乎可以节省术前血红蛋白在 12 至 15g/dL 之间的患者的成本。对于术前血红蛋白>15g/dL 的患者，这种方法并不节省成本，而对于术前血红蛋白<12g/dL 的患者，尽管节省成本，但通过结合其他一些血液保存方法，其效果可能会提高。
