Department of Medical Decision Making, Leiden University Medical Center, J10-S, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for L. van Bodegom-Vos:
Sanquin Research, Jon J. van Rood Netherlands Center for Clinical Transfusion Research, Plesmanlaan 1a, 2333 BZ Leiden, the Netherlands.
J Bone Joint Surg Am. 2015 Jun 17;97(12):1012-21. doi: 10.2106/JBJS.N.00315.
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.
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.
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.
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.
细胞回收术用于减少全髋关节置换术（THA）和全膝关节置换术（TKA）中的同种异体红细胞（RBC）输血。我们进行了一项荟萃分析，以评估细胞回收术分别减少 THA 和 TKA 输血的效果，并检查最近的试验是否改变了以前荟萃分析的结论。
我们通过搜索 MEDLINE，截至 2013 年 1 月，检索评估细胞回收术在 THA 和 TKA 中的效果的随机临床试验。使用标准化表格提取试验结果，并使用随机效应模型进行汇总。使用 Cochrane 协作组的风险偏倚评估工具评估试验的方法学质量。
共纳入 43 项试验（5631 例患者）。总体而言，细胞回收术减少了 THA（风险比 [RR]，0.66；95%置信区间 [CI]，0.51 至 0.85）和 TKA（RR，0.51；95% CI，0.39 至 0.68）异体 RBC 输血的暴露。然而，2010 年至 2012 年发表的试验，风险偏倚较低，显示细胞回收术在 THA 中无显著效果（RR，0.82；95% CI，0.66 至 1.02）和 TKA（RR，0.91；95% CI，0.63 至 1.31），表明随着时间的推移，输血治疗政策可能发生了变化。
纵观所有试验，细胞回收术仍显著降低了 THA 和 TKA 的 RBC 暴露率和输血量。然而，在最近（2010 年至 2012 年）发表的试验中，细胞回收术既没有降低 THA 和 TKA 的 RBC 暴露率，也没有降低输血量，这很可能是由于输血管理的变化所致。
