Tsukada Sachiyuki, Wakui Motohiro, Kurosaka Kenji, Saito Masayoshi, Nishino Masahiro, Hirasawa Naoyuki
Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Mito, Japan.
Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan.
JB JS Open Access. 2023 Jan 20;8(1). doi: 10.2106/JBJS.OA.22.00125. eCollection 2023 Jan-Mar.
This study was performed to examine the hypothesis that the rate of allogeneic blood transfusion in patients who did not predeposit an autologous blood transfusion before single-anesthetic bilateral total knee arthroplasty (TKA) would be noninferior to that in patients who did predeposit blood.
We assessed the number of allogeneic transfusions required in 338 patients undergoing single-anesthetic bilateral TKA with a preoperative hemoglobin level of ≥11.0 g/dL. All TKAs were performed by a single surgeon according to the same operative and postoperative protocol. All patients received a combination of intravenous and intra-articular tranexamic acid. Neither a pneumonic tourniquet nor a drain was used. The difference in the risk of allogeneic transfusion between patients without and with autologous blood predeposit was compared with a noninferiority margin of 10 percentage points.
Allogeneic transfusion was required in 1 (0.5%) of 194 patients who predeposited autologous blood and 3 (2.1%) of 144 patients who did not predeposit blood. The difference in risk was -1.6 percentage points (95% confidence interval, -4.1 to 1.0 percentage points); the confidence interval did not include the noninferiority margin and included zero.
In single-anesthetic bilateral TKA, allogeneic transfusion requirements in patients who did not predeposit autologous blood were noninferior to those in patients who predeposited blood.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在检验以下假设：在单次麻醉双侧全膝关节置换术（TKA）前未预存自体血的患者中，异体输血率不劣于预存自体血的患者。
我们评估了338例术前血红蛋白水平≥11.0 g/dL、接受单次麻醉双侧TKA的患者所需的异体输血量。所有TKA手术均由同一外科医生按照相同的手术和术后方案进行。所有患者均接受静脉和关节内注射氨甲环酸联合治疗。未使用气囊止血带和引流管。比较了未预存自体血和预存自体血患者异体输血风险的差异，非劣效界值为10个百分点。
194例预存自体血的患者中有1例（0.5%）需要异体输血，144例未预存自体血的患者中有3例（2.1%）需要异体输血。风险差异为-1.6个百分点（95%置信区间，-4.1至1.0个百分点）；置信区间未包括非劣效界值且包含零。
在单次麻醉双侧TKA中，未预存自体血患者的异体输血需求不劣于预存自体血的患者。
治疗性III级。有关证据水平的完整描述，请参阅《作者须知》。
