Hulse Narayan, Raghu B V, Yogarakshith A R
Department of Orthopaedics, Fortis Hospital, Bannerghatta road, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bengaluru, India.
J Clin Orthop Trauma. 2025 Mar 25;65:102987. doi: 10.1016/j.jcot.2025.102987. eCollection 2025 Jun.
In simultaneous bilateral total knee arthroplasties (TKA), the blood transfusion rate could be higher, considering the cumulative blood loss from both knees. Due to its continuous suction mechanism, closed drainage can increase the amount of postoperative bleeding and drainage. In this study, we evaluated the effect of suction drain on postoperative blood transfusion in patients undergoing simultaneous bilateral TKA.
Consecutive 400 primary simultaneous bilateral TKAs were studied. In the 'drain group' of 100 consecutive patients (200 TKAs), a suction drain was used, and in the subsequent consecutive 100 patients (200 knees, 'No drain group'), no drain was used. The volume of postoperative suction drainage, hemoglobin, hematocrit, transfusion requirements, and related complications are studied retrospectively. Data was collected using patient case notes, blood bank data, and the laboratory data, which is stored digitally for all the patients in the hospital electronic database.
In the "drain group", the combined mean collection in the suction drain was 527.2 ml (±273.2 ml). The mean post-operative change in the hemoglobin was 2.63 gm/dl (±1.06 gm/dl). There were 31 patients with post-operative hemoglobin below 8 gm/dl requiring 49 units of packed cells transfused.In the No-drain group, the mean post-operative change in hemoglobin was 2.42 gm/dl (±1.005 gm/dl). There were 16 patients with postoperative Hemoglobin below 8 gm/dl requiring 21 pints of packed cells transfusion in this group. The greater drop in the postoperative hemoglobin percentage occurred in the "Drain group", which is statistically significant. The blood transfusions from the two groups yielded a p-value of 0.0057, which is also statistically significant.
Our study concludes that no drainage in primary simultaneous bilateral TKA may reduce the need for blood transfusions compared to the closed suction drain.
在同期双侧全膝关节置换术（TKA）中，考虑到双膝的累计失血量，输血率可能会更高。由于其持续吸引机制，闭式引流会增加术后出血量和引流量。在本研究中，我们评估了吸引引流对同期双侧TKA患者术后输血的影响。
对连续400例初次同期双侧TKA患者进行研究。在连续100例患者（200膝，“引流组”）中使用吸引引流，在随后连续的100例患者（200膝，“无引流组”）中不使用引流。回顾性研究术后吸引引流量、血红蛋白、血细胞比容、输血需求及相关并发症。使用患者病历、血库数据和实验室数据收集数据，这些数据以数字形式存储在医院电子数据库中的所有患者中。
在“引流组”中，吸引引流的平均总引流量为527.2 ml（±273.2 ml）。术后血红蛋白的平均变化为2.63 g/dl（±1.06 g/dl）。有31例患者术后血红蛋白低于8 g/dl，需要输注49单位的浓缩红细胞。在无引流组中，术后血红蛋白的平均变化为2.42 g/dl（±1.005 g/dl）。该组有16例患者术后血红蛋白低于8 g/dl，需要输注21单位的浓缩红细胞。术后血红蛋白百分比下降幅度更大的是“引流组”，具有统计学意义。两组输血的p值为0.0057，也具有统计学意义。
我们的研究得出结论，与闭式吸引引流相比，初次同期双侧TKA不进行引流可能会减少输血需求。
