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1.
Comparison of the effects of different blood conservation techniques in elderly patients undergoing total hip arthroplasty
Cai, Y., He, X., Cheng, Q.
African health sciences. 2023;23(3):514-520
Abstract
BACKGROUND To probe into the influences of different blood conservation techniques on the postoperative coagulation function and prognosis of elderly patients receiving Total Hip Arthroplasty (THA). METHODOLOGY A total of 60 patients were randomly divided into Autologous Blood Transfusion (ABT) group (n=30) and ANH group (n=30). For patients in the ABT group, an autologous blood recovery machine was used to recover, wash and filter the surgical field blood. For those in the Acute Isovolumic Hemodilution (ANH) group, blood was collected preoperatively from the central vein and stored in a citrate anticoagulant blood storage bag, while the same amount of hydroxyethyl starch was injected into the peripheral vein to dilute the blood. After Mai bleeding steps of the operation were completed, the autologous blood of patients was transfused back in both groups. The clinical indicators of patients in each group were observed. RESULTS 48 h after operation, the ANH group obtained a higher level of hemoglobin (Hb), shorter Activated Partial Thromboplastin Time (APTT), and a lower expression rate of platelet activating factor CD62P than the ABT group. CONCLUSION The ANH group exhibits higher content of hemoglobin and fewer platelet (Plt)activating factors produced than the ABT group, while no significant difference in the shortened length of hospital stays is found.
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2.
A prospective randomized study, use of closed suction drainage after revision hip arthroplasty may lead to excessive blood loss
Bartosz P, Grzelecki D, Chaberek S, Para M, Marczyński W, Białecki J
Scientific reports. 2022;12(1):881
Abstract
Suction drainage after primary total hip arthroplasties (THA) offers no benefits. Revision hip arthroplasties (RHA) are more demanding procedures and associated with greater blood loss compared to primary cases. There is still a lack of literature regarding the application of drainage in RHA. A total of 40 patients who underwent RHA were included in this prospective study. Simple randomization with an allocation ratio 1:1 was performed. Primary outcomes: total blood loss, hemoglobin drop, joint hematoma size in USG, infection. Secondary outcomes: blood transfusion rate, soft tissue hematomas, C-reactive protein levels, Visual Analogue Scale before and on 3rd day after surgery, Harris Hip Score before and 6 weeks after surgery. An intention to treat analysis was performed, with a 2-year follow up. Statistically significant differences between groups was in blood loss: drainage 1559.78 ml, non-drainage 1058.27 ml, (p = 0.029) and hemoglobin level on 1st day after surgery: drainage 10.58 g/dl, non-drainage 11.61 g/dl (p = 0.0496). In terms of the other analyzed parameters, statistical differences were not found. Our study revealed that the use of suction drainage may lead to higher blood loss in the early postoperative period. Further studies are needed to evaluate our results.
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3.
Wound drainage after proximal femoral nail antirotation (PFNA) fixation may negatively affect the patients with intertrochanteric fractures: A prospective randomized controlled trial
Chang, H. M., Lu, W. Y., Kuan, F. C., Su, W. R., Chen, P. Y., Su, P. F., Hsu, K. L.
Injury. 2021;52(3):575-581
Abstract
INTRODUCTION The effect of using closed suction drainage system with the proximal femoral nail antirotation (PFNA) system fixation on outcomes in treating intertrochanteric fractures (ITFs) is still unknown. This prospective randomized controlled trial aimed to examine whether routine drainage is useful for PFNA fixation in ITFs. METHODS A total of 80 patients with acute ITFs were treated with closed or mini-open reduction with PFNA fixation at the National Cheng Kung University Hospital and 60 eligible patients were randomized for whether to receive suction drainage. In clinical outcomes, the visual analog scale (VAS), morphine equivalent dosage, injured thigh width, body temperature, wound condition and wound infection were measured on postoperative day 1, 2, 4, 10, and 90. In laboratory outcomes, we evaluated hemoglobin and hematocrit levels postoperatively at different time points. Blood transfusion and total blood loss (TBL) were measured by Mercuriali's formula in millimeter. RESULTS The results revealed that the amount of blood transfusion received by the drained group (543.3 mL) was more than that by the undrained group (367.8 mL; p = 0.0074), and similarly, TBL in the drained group (750.1 mL) was more than that in the undrained group (537.4 mL; p = 0.0067). Regarding clinical and laboratory outcomes, compared with the undrained group, the drained group had a higher VAS score on postoperative day 2 (p = 0.0216). No difference was observed between the 2 groups for morphine equivalent dosage, thigh swelling, wound infection and hematoma, hospitalization period, or total number of complications at every time point after index procedure. CONCLUSIONS Blood transfusion requirement and TBL were higher in the drained group than in the undrained group of PFNA fixation for ITFs. In addition, the closed drainage system may have manifested no short-term benefit for wound condition postoperatively.
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4.
Effects of stored autotransfusion on electrolytes and postoperative complications in patients undergoing elective orthopedic surgery
Han Z, Wang M, Yu S
American journal of translational research. 2021;13(6):7200-7206
Abstract
OBJECTIVE To ivestigate the effect of stored autotransfusion on the electrolytes and postoperative complications in patients undergoing elective orthopedic surgery. METHODS A total of 76 cases of patients undergoing elective orthopedic surgery were randomly divided into an observation group (38 cases, taking stored autotransfusion) and a control group (38 cases, taking allogeneic blood transfusion) according to a random number table method. The intraoperative-related indexes (intraoperative blood loss, autologous or allogeneic blood transfusion volume, urine volume, and length of hospital stay), electrolyte levels before and 48 hours after the operation, routine blood and coagulation function were compared between the two groups, and the postoperative complications related to blood transfusion were recorded. RESULTS The length of hospital stay of the observation group was significantly lower than that of the control group (P<0.05). The concentrations of K(+) and Na(+) in the control group 48 h after the operation were higher than those before the operation and than those in the observation group, while the concentration of Ca(2+) was lower than that before the operation and that in the observation group (all P<0.05). The levels of Hb, RBC, and HCT in the control group 48 h after the operation were lower than those before the operation and those in the observation group (all P<0.05). The levels of WBC in the two groups 48 h after the operation were significantly higher, but those in the observation group were lower than those in the control group (all P<0.05). There were no significant changes in Pt, APTT, D-D, and FIB levels between the two groups. There were no significant changes in Pt, APTT, D-D, and FIB levels 48 hours after the operation compared with those before the operation (P>0.05). The incidence of postoperative complications caused by blood transfusion in the observation group was lower than that in the control group (P<0.05). CONCLUSION Storage autotransfusion can effectively balance the electrolyte level and reduce the incidence of complications in patients undergoing elective orthopedic surgery. This is worthy of clinical application.
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5.
Prophylactic Closed Suction Drainage Is Irrelevant to Accelerated Rehabilitation after Open Reduction and Internal Fixation for Closed Distal Femur Fractures
Zhang, J. Z., Zhao, K., Li, J. Y., Meng, H. Y., Zhu, Y. B., Zhang, Y. Z.
Orthopaedic Surgery. 2020;12(6):1768-1775
Abstract
OBJECTIVE To investigate whether closed suction drainage (CSD) is related to accelerated rehabilitation of patients after open reduction and internal fixation (ORIF) for closed distal femur fractures. METHODS This study was a prospective, randomized controlled clinical trial. Between October 2018 and June 2020, 160 closed distal femur fracture patients who were prepared for ORIF were prospectively randomized into two groups: a CSD group with the mean age of 57.91 ± 14.38 years (32 [40%] men and 48 [60%] women) and a non-CSD group with the mean age of 59.73 ± 17.55 years (27 [34%] men and 54 [66%] women). Wound visual analogue scale (VAS) pain scores, peri-wound skin temperature, hematocrit (Hct), hemoglobin (Hb) concentrations, hidden blood loss (HBL), dressing change, period of wound oozing, postoperative blood transfusion, and length of postoperative hospital stay were recorded. Postoperative wound complications, namely wound infections, wound haematoma, wound dehiscence, erythema of wound, and lower limb deep vein thrombosis (DVT) were collected. All the patients were administrated by a single surgical team and followed up for 1 month after the ORIF. RESULTS The patients without CSD were identified with lower peri-wound skin temperature and wound VAS pain scores during the first three postoperative days (36.69 ± 0.33 vs 36.86 ± 0.38 °C, P = 0.002; 1.88 ± 0.82 vs 3.15 ± 1.15, P = 0.000). However, both the peri-wound skin temperature and wound VAS pain scores did not differ significantly between the two groups on the fifth postoperative day. In addition, patients with CSD had a longer length of postoperative hospitalization time (11.45 ± 5.95 vs 9.78 ± 4.64 days, P = 0.049). There was no statistically significant difference between CSD and non-CSD groups within 1 month after the ORIF regarding blood loss, period of wound oozing, and postoperative complications, such as incidence of wound infection, haematoma, erythema, dehiscence, and lower limb DVT. CONCLUSION Prophylactic CSD after primary ORIF for closed distal femur fractures not only had no significant advantage to minimize blood loss and wound complications, but increased local inflammation and postoperative hospital stay, and thus we suggest that prophylactic CSD after primary ORIF for closed distal femur fractures is not recommended for optimized clinical pathways and accelerated recovery.
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6.
Is serum gentamicin concentration modified with autologous cell-saved blood transfusion after total knee arthroplasty using tranexamic acid? A randomized control trial
Touzopoulos P, Arvanitidis K, Filidou E, Tilkeridis K, Karanikas M, Kolios G, Ververidis A
Orthopaedics & traumatology, surgery & research : OTSR. 2020;:102794
Abstract
BACKGROUND Self-transfusion has been proven as an effective management of blood loss after total knee arthroplasty (TKA). Considering that the high local concentration of antibiotic from bone cement is delivered intravenously through the self-transfusion process, systematic toxicity has never been evaluated. In addition, the effectiveness of self-transfusion with the routine concomitant use of other modern blood-salvage strategies, like tranexamic acid, should also be assessed. Therefore we performed a randomized study to assess: 1) the safety of self-transfusion in TKA by comparing the gentamicin concentrations resulting from the use or not of autologous blood transfusion. 2) the efficacy of self-transfusion in TKA, with the concomitant administration of tranexamic acid Hypothesis: Self-transfusion in TKA elevates the serum gentamicin concentration and the potential risk of nephrotoxicity. METHODS The serum concentration of aminoglycosides was measured in two groups of 20 patients each, after TKA, according to the use of self-transfusion. Hemoglobin, renal function and calculated blood loss were compared at several points in time between groups. RESULTS The only time where there was a statistically significant difference in serum gentamicin, was at 48h postoperatively between groups [0.3 ug/ml ± 0.21, range: 0.15 to 0.72 vs. 0.14ug/ml ± 0.1, range: 0 to 0.35 (p=0.02)]. There were no significant differences in total blood loss [1341ml ± 501, range: 830 to 2230 vs. 1263ml ± 459 range: 840 to 2480 (p=0.67)] and need of allogeneic blood transfusion [3 units vs. 2 units] between groups. CONCLUSION The use of autologous blood transfusion was found to be safe, in terms of nephrotoxicity of aminoglycosides after TKA, but it seemed to be ineffective as a blood salvage strategy, when used concomitantly with the administration of tranexamic acid. LEVEL OF EVIDENCE II; low powered randomized study.
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7.
Drainage relieves pain without increasing post-operative blood loss in high tibial osteotomy: a prospective randomized controlled study
Li S, Yang J, Watson C, Lu Q, Zhang M, Miao Z, Luo D, Liu P
Int Orthop. 2020
Abstract
PURPOSE Drainage is a common procedure in high tibial osteotomy (HTO), but the benefits of drainage during HTO remain poorly investigated. This study was designed to investigate the effect of drainage on blood loss and early functional recovery in HTO. METHODS Altogether, 80 patients undergoing HTO were analyzed from August 2018 to September 2019. Patients were randomized into two groups: group A (drainage, n = 40) and group B (no drainage, n = 40). There were no intergroup differences in baseline parameters between the two groups, and the same surgical techniques and haemostatic methods were used. The mean follow-up time was 3.2 months. Blood loss and early functional recovery of the knee were examined post-operatively in both groups. RESULTS The total post-operative blood loss was 253.34 +/- 104.18 ml in group A and 222.51 +/- 106.89 ml in group B. This difference was non-significant (p > 0.05). The post-operative haemoglobin and haematocrit differences between groups were also non-significant (p > 0.05). Post-operative visual analogue scale (VAS) pain scores and lower leg swelling were lower in group A than those in group B (p < 0.05), and the early range of motion of the knee joint was higher in group A than that in group B (p < 0.05). Group A had lower incidence rates of dressing seepage and incision complications than group B (p < 0.05). The differences in three month post-operative VAS and knee function scores were non-significant (p > 0.05). CONCLUSION Drainage in HTO does not increase patients' total blood loss, but it can promote early knee function recovery by reducing post-operative pain, lower leg swelling, and the incidence of incision complications. TRIAL REGISTRATION NCT-03954860.
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8.
Acute normovolemic hemodilution in major orthopedic surgery
Bansal N, Kaur G, Garg S, Gombar S
Journal of clinical orthopaedics and trauma. 2020;11(Suppl 5):S844-s848
Abstract
BACKGROUND With increasing concerns regarding the newer emerging pathogens, alternatives to allogeneic blood transfusion are being explored and acute normovolemic hemodilution (ANH) is one of them. METHODS A prospective study was conducted in patients aged 18-65 years with preoperative hemoglobin >12 g/dl undergoing total knee replacement or total hip replacement. Patients in whom hemodilution was performed were included in the ANH group whereas patients undergoing treatment as per the routine hospital protocol were included in the control group. RESULTS Preoperative hemoglobin was similar in both ANH and control groups (12.7 ± 0.7 vs 12.6 ± 0.6, p = 0.56). Allogeneic blood requirement was significantly less in the ANH group as compared to the control group (4 vs 15, p = 0.001). Postoperative complications were significantly lower in ANH group as compared to control group (7 vs 16, p = 0.01). CONCLUSIONS ANH can be an alternative approach to meet the need of safe blood especially in resource constrained countries, like India where risk of transfusion transmitted infections are still high and where there is high demand of blood and acute shortage of blood in hospitals.
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9.
Role of Suction Drain after Knee Arthroplasty in the Tranexamic Acid Era: A Randomized Controlled Study
Maniar RN, Pradhan P, Bhatnagar N, Maniar A, Bidwai R, Bindal P
Clinics in orthopedic surgery. 2019;11(1):73-81
Abstract
Background: Postoperative suction drains are used after total knee arthroplasty to avoid intra-articular hematoma formation although they can increase blood loss due to a negative suction effect. The use of tranexamic acid to reduce blood loss may nullify this. The aim of this study was to compare outcomes in patients undergoing total knee arthroplasty with or without drains and to analyze whether the drain's diameter also has an impact. Methods: This is a prospective randomized study of patients undergoing unilateral total knee arthroplasty performed by a single surgeon. The study population was divided into three groups (A, 10G drain; B, 12G drain; and C, no drain). Pain, blood loss, swelling, wound-related complications, functional outcomes and questionnaire-based outcomes were assessed postoperatively. Results: Each group had 35 patients comparable in most demographic and pre- and intraoperative characteristics. During the first 6 hours postoperatively, opioid consumption was significantly higher when the drain was not used (p = 0.036). At 3 months postoperatively, new Knee Society Score (NKSS) was highest with the use of 12G drain (p = 0.018). However, NKSS at 1 year was comparable across the three groups. With the use of tranexamic acid, blood loss and incidence of soakage of dressing were unaffected by the presence or absence of a drain. The calf girth, suprapatellar girth, soakage of dressing and range of motion were comparable in all three groups. There was no incidence of surgical site infection or deep vein thrombosis. Conclusions: Presence of a suction drain significantly reduces opioid consumption during the first 6 hours after total knee arthroplasty. Use of a drain made no difference to the functional outcome at 1 year postoperatively. With the use of tranexamic acid in total knee arthroplasty, the total blood loss and the requirement of blood transfusion were unaffected by the presence or absence of closed suction drainage or by the bore of the drain used. The clinical parameters such as swelling, range of motion, infection and deep vein thrombosis also remained the same.
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10.
A comparison of the use and non-use of closed suction wound drainage in open reduction and internal fixation of femoral shaft fractures
Muoghalu ON, Eyichukwu GO, Iyidobi E, Anyaehie UE, Madu KA, Okwesili IC
International orthopaedics. 2019
Abstract
PURPOSE The aim of this study was to determine if the routine use of closed suction wound drainage is justified following open reduction and internal fixation (ORIF) of femoral shaft fractures. METHOD This was a prospective comparative study of two study groups: those with post-operative closed suction drainage (WCSD) and those not with closed suction drainage (NWCSD). RESULTS Fifty-six patients, twenty-eight each for the two cohorts, were recruited for this study. Five patients (17.9%) in the WCSD group and only one patient (3.6%) in NWCSD group had surgical site infection (p = 0.20). Four patients (14.3%) in the WCSD group and nine (32.1%) in NWCSD group had wound dressing reinforcements (p = 0.21). CONCLUSION There was generally no statistically significant difference in the incidence of wound infections, strike through bloodstain with wound dressing reinforcement and duration of hospital stay in patients with and without closed suction wound drainage after ORIF of femoral shaft fractures. The duration of the injury may however influence the decision to use or not use wound drain after surgery.