Allogeneic blood transfusion decreases with postoperative autotransfusion in hip and knee arthroplasty. An analysis of blood management in patients having a total hip or knee arthroplasty. Clinical efficacy of postoperative autologous transfusion of filtered shed blood in hip and knee arthroplasty. A randomized trial of acute normovolemic hemodilution compared to preoperative autologous blood donation in total knee arthroplasty. Blood management in total knee arthroplasty: a comparison of techniques. A cluster-randomized controlled trial of a blood conservation algorithm in patients undergoing total hip joint arthroplasty. Predonated autologous blood transfusions after total knee arthroplasty: immediate versus delayed administration. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Preoperative use of recombinant human erythropoietin before total joint arthroplasty. Autologous blood transfusion after primary unilateral total knee replacement surgery. Intraoperative Autotransfusion in Hip Arthroplasty Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle. Retransfusion of filtered shed blood in primary total hip and knee arthroplasty: a prospective randomized clinical trial. A randomized trial comparing acute normovolemic hemodilution and preoperative autologous blood donation in total hip arthroplasty. An individualized pre-operative blood saving protocol can increase pre-operative haemoglobin levels and reduce the need for transfusion in elective total hip or knee arthroplasty. Autologous blood transfusion in revision hip arthroplasty. A prospective, controlled study of 30 patients. Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen. The Rizzoli Study Group on Orthopaedic Anaesthesia.
OBJECTIVES We aim ed to evaluate the effectiveness of postoperative autotransfusion method on prevention of the need of allogeneic blood transfusion  in hip and knee arthroplasty . METHODS Seventy-four patients who underwent 77 hip and knee arthroplasty operations were r and omized into control and study groups , and evaluated prospect ively . In the knee group ( 39 patients ; 30 females , 9 males ; mean age 66.6 years ) , cemented , cruciate retaining , and bicompartmental arthroplasty was performed under tourniquet control ; whereas in the hip group ( 35 patients ; 24 females , 11 males ; mean age 59.3 years )  cementless arthroplasty with posterolateral approach was performed . None of the patients received preoperative and intraoperative allogeneic blood transfusion . The collected blood in the surgical area was transfused with autotransfusion system to the patients in the study groups at the end of the fourth hour postoperatively . The mean amounts of autotransfused blood in hip and knee groups were 413 mL and 480 mL , respectively . Allogeneic blood transfusion was applied to the patients with hemoglobin level below 8 g/dL , hematocrit level below 25 % , and clinical symptoms of anemia . RESULTS Preoperative and postoperative hemoglobin-hematocrit levels did not differ significantly between study and control groups .  Allogeneic blood transfusion  was applied to one patient ( 5 % ) in study and 8 patients ( 38 % ) in control groups during knee arthroplasty ( p=0.01 ) ; whereas 9 patients ( 53 % ) in study and 15 patients ( 79 % ) in control groups received  allogeneic blood transfusion  during hip arthroplasty ( p=0.044 ) . The amount of allogeneic blood transfusion in study groups was significantly lower than that in control groups ( p=0.008 for knee arthroplasty , p=0.048 for hip arthroplasty ) . CONCLUSION The need and amount of allogeneic transfusion were reduced with postoperative autotransfusion in both knee and hip arthroplasty groups with greater extent in knee arthroplasty Three hundred and thirty orthopaedic surgeons in the United States participated in a study of transfusion requirements associated with total joint arthroplasty . A total of 9482 patients ( 3920 patients who had a total hip replacement and 5562 patients who had a total knee replacement ) were evaluated prospect ively from September 1996 through June 1997 . Of those patients , 4409 ( 46 percent [ 57 percent of the patients who had a hip replacement and 39 percent of the patients who had a knee replacement ] ) had a blood transfusion . Two thous and eight hundred and ninety patients ( 66 percent ) received autologous blood , and 1519 patients ( 34 percent ) received allogenic blood . Ordered logistic regression analysis showed the most important predictors of the transfusion of allogenic blood to be a low baseline hemoglobin level and a lack of predonated autologous blood . Preoperative donation of autologous blood decreases the risk of transfusion of allogenic blood ; however , inefficiencies in the procedures for obtaining autologous blood were identified . Sixty-one percent ( 5741 ) of the patients had predonated blood for autologous transfusion , but 4464 ( 45 percent ) of the 9920 units of the predonated autologous blood were not used . Primary procedures and revision total knee arthroplasty were associated with the greatest number of wasted autologous units . Of the 5741 patients who had predonated blood , 503 ( 9 percent ) needed a  transfusion of allogenic blood .  The frequency of allogenic blood transfusion  varied with respect to the type of operative procedure ( revision total hip arthroplasty and bilateral total knee arthroplasty were associated with the highest prevalence of such transfusions ) and with a baseline hemoglobin level of 130 grams per liter or less . Transfusion of allogenic blood was also associated with infection ( p < or = 0.001 ) , fluid overload ( p < or = 0.001 ) , and increased duration of hospitalization ( p < or = 0.01 ) . These latter findings warrant further evaluation in controlled studies BACKGROUND Total knee arthroplasty ( TKA ) or total hip arthroplasty ( THA ) regularly results in postoperative requirement of blood transfusion . Because of the disadvantages of allogeneic blood transfusion ( ABT ) such as the risk of transfusion-associated infections , incompatibility-related transfusion fatalities , or immunomodulatory effects , a continuing effort to reduce allogeneic blood transfusion is important . For this purpose , the effect of reinfusion of drain blood , via a postoperative wound drainage and reinfusion system , on the need for allogeneic blood transfusion was evaluated . STUDY DESIGN AND METHODS Using a prospect i ve observational quality assessment design , we compared 135 patients scheduled for TKA or THA with a historic group of 96 patients . In the study group the Bellovac ABT autotransfusion system was used . The shed blood was returned either when 500 mL were collected or at most 6 hours after surgery . Compared were the preoperative , postoperative , and discharge hemoglobin , as well as the number of allogeneic blood transfusions . RESULTS There were no statistical differences between preoperative , postoperative , and discharge hemoglobin levels . Autologous transfusion reduced the number of patients receiving ABT overall from 35 percent ( control ) to 22 percent ( study ) . The decrease of allogeneic transfusion requirement was most significant after TKA : from 18 percent to 6 percent ( p < 0.001 ) . CONCLUSION We conclude that the Bellovac ABT device reduces allogeneic blood transfusions in TKA and THA The value of acute normovolemic hemodilution ( ANH ) compared to preoperative autologous blood donation ( PAD ) in elective surgery is controversial . We therefore conducted a prospect i ve , r and omized study to compare these techniques in patients undergoing total knee arthroplasty . ANH patients underwent up to 4 units phlebotomy or to a target hematocrit level of 28 % after induction of anesthesia .  PAD patients were asked to donate 1 ( unilateral ) or 2 ( bilateral , revisions ) units before admission . Mean baseline hematocrit levels were not different between ANH and PAD patients ( 40.6+/-4.1 vs. 38 . 4+/-3.4 , p = 0.09 ) . Eight ( 73 % ) of 11 patients undergoing bilateral revision procedures received a total of 22 allogeneic blood units , whereas only 3 ( 14 % ) of 21 patients undergoing primary , unilateral procedures received a total of 3 allogeneic units ( p = 0.002 ) . We found no differences in allogeneic blood transfusions between ANH and PAD cohorts for all ( n = 32 ) patients ( 1.0+/-1.2 vs. 0.6+/-1.4 , p = 0.45 ) , for unilateral knee ( n = 21 ) replacement ( 0.25+/-0.46 vs. 0.08+/-0.28 , p = 0.29 ) , or for bilateral/revision ( n = 11 ) procedures ( 1.9+/-1.3 vs. 2.5+/-1.9 , p = 0.53 ) . We conclude that each technique is equally effective in reducing allogeneic blood exposure .  Patients undergoing revision or bilateral knee arthroplasties require adjunctive therapy to autologous blood procurement to further reduce allogeneic blood exposure Patients undergoing total knee arthroplasty ( TKA ) are at high risk for postoperative anemia and allogeneic blood transfusions . Risks associated with allogeneic blood exposure ( ie , infection , fluid overload , and longer hospital stays ) have prompted alternative blood management strategies . The main goal of this study was to evaluate whether a single change in the clinical blood management of patients undergoing TKA reduced the severity of postoperative anemia or the need for allogeneic blood transfusions . A second goal of this study was to assess the financial impact of the change on the institution . This study compared perioperative cell salvage , preoperative autologous blood donation , and the practice of using allogeneic blood alone in patients undergoing TKA . Clinical and financial data of 154 unique cases of primary TKA at the Mayo Clinic Arizona were retrospectively review ed .  Transfusion rates were 25 % , 18 % , and 52 % respectively for patients in the  cell salvage , preoperative autologous blood donation , and  allogeneic blood only  groups . Respective relative risk reductions were 51.9 % ( P=.007 ) and 65.4 % ( P=.002 ) with the use of cell salvage or preoperative autologous blood donation versus allogeneic alone . Cell salvage and preoperative autologous blood donation were found to significantly reduce the requirements for allogeneic blood transfusions ; these techniques were found to be roughly equivalent in clinical benefit when compared to the use of allogeneic blood alone . The logistical advantages of cell salvage ( ie , no preoperative blood donation , no risk of wasting blood units ) were associated with greater costs to the institution BACKGROUND The optimum strategy for reducing allogeneic blood transfusion in patients undergoing total hip joint arthroplasty ( THJA ) is unknown . STUDY DESIGN AND METHODS The effectiveness of a comprehensive blood conservation algorithm ( BCA ) was evaluated by means of a cluster r and omization trial . Thirty hospitals performing primary THJA were r and omly assigned to implement the algorithm or to continue with usual care ( UC ) . Subsequently , the institutional rate of allogeneic transfusion was determined for 60 consecutive patients who underwent surgery at each site . The BCA consisted of patient and provider education , hemoglobin-based recommendations for specific blood conservation strategies ( recombinant human erythropoietin [ rHuEPO ] or autologous blood donation [ ABD ] ) and transfusion guidelines . The main outcome measure was the institutional allogeneic transfusion rate . RESULTS One hospital withdrew consent after r and omization , result ing in 14 hospitals assigned to BCA and 15 to UC . In the BCA arm , the institutional rates of rHuEPO use and ABD participation were 20.1 and 27.1 percent compared to 0.6 and 25.8 percent , respectively , in the UC arm . The allogeneic transfusion rate was substantially reduced in hospitals assigned to the BCA group ( p = 0.02 ; absolute risk reduction , 9.6 % [ 26.1 % UC vs. 16.5 % BCA ] ) . Multivariate analysis of patient-level data showed that assignment to the UC arm was an independent risk factor for allogeneic transfusion ( p = 0.037 ; odds ratio , 1.8 ; 95 % confidence interval , 1.0 - 3.1 ) when adjusted for other prognostic factors . No differences were observed in the use of autologous blood . CONCLUSION A comprehensive approach to blood conservation was superior to UC for reducing allogeneic transfusion in patients undergoing THJA Efforts to avoid complications associated with transfusion of allogeneic blood have increased the use of preoperatively donated autologous blood ( PAB ) . A major controversy has arisen : Should the same criteria be used for transfusion of autologous as allogeneic red cells ? This study prospect ively and r and omly compared giving PAB immediately after total knee arthroplasty ( TKA ) , beginning in the recovery room or delaying a transfusion until the patient 's hemoglobin had fallen to less than a 9.0 g/dL transfusion trigger point . The results show that patients who received immediate transfusion had fewer nonsurgical complications ( P < .002 ) . Because TKAs are associated with an average blood loss of 1,400 mL , we recommend that PAB be used in the immediate postoperative period , especially in the elderly , in whom the risk for cardiac or nonsurgical complications is inherently increased BACKGROUND The purpose of this study was to assess current practice s in blood management in elective orthopedic surgery in Europe . STUDY DESIGN AND METHODS For this 225-center prospect i ve survey , data were collected on 3996 patients .  Actual perioperative blood loss was compared to preoperative estimates . Differences in Hb levels and other outcome variables for patients receiving allogeneic versus autologous transfusions  were evaluated . The probability of allogeneic transfusion  based on selected predictor variables was estimated . RESULTS A total of 2640 ( 67 % ) hip and 1305 ( 33 % ) knee arthroplasty patients were evaluated .  Estimated blood loss ( median , 750 mL ) was significantly lower than computed blood loss ( median , 1944 mL ) . A total of 2762 ( 69 % ) patients received  transfusions  , including 1393 ( 35 % ) autologous-only and 1024 ( 25 % ) allogeneic-only . The probability of allogeneic transfusion  decreased with increasing baseline Hb , but differentially so for men and women . Transfusion triggers were Hb levels of 8.93 + /- 1.83 g per dL for allogeneic transfusions , and 21 percent of these occurred when the Hb level was greater than 10 g per dL. Autologous blood transfusion was associated with a significantly lower rate ( 1 % ) of wound infections than allogeneic blood transfusion ( 4.2 % ) . CONCLUSION Accurate assessment of preoperative Hb levels , better estimation of perioperative blood loss , efficient use of autologous blood , adherence to transfusion guidelines , and pharmacologic alternatives contribute to effective and comprehensive blood and anemia management BACKGROUND Previous reports have suggested that the use of recombinant human erythropoietin is effective for decreasing the need for perioperative allogeneic blood transfusion . The purpose of this study was to evaluate the efficacy of erythropoietin in combination with , and compared with , preoperative autologous donation for reducing allogeneic blood requirements for total joint arthroplasty . METHODS Two hundred and forty patients undergoing primary and revision total hip or knee arthroplasty were enrolled into three groups with different treatment regimens : ( 1 ) erythropoietin and preoperative autologous donation ( Group 1 ) , ( 2 ) erythropoietin alone ( Group 2 ) , and ( 3 ) preoperative autologous donation alone ( Group 3 ) . Patients were evaluated with regard to requirements for allogeneic transfusion , change from the baseline to the lowest postoperative hemoglobin value , postoperative complications , and adverse reactions . RESULTS The rate of allogeneic transfusion was 11 % in Group 1 ( erythropoietin and preoperative autologous donation ) compared with 28 % in Group 2 ( erythropoietin alone ) and 33 % in Group 3 ( preoperative autologous donation alone ) . Within Group 1 , patients who had a unilateral primary arthroplasty had an allogeneic transfusion rate of 4 % and those who had a bilateral or revision arthroplasty had an allogeneic transfusion rate of 17 % . In Groups 2 and 3 , the allogeneic transfusion rates were 14 % and 15 % , respectively , for the patients who had a unilateral primary arthroplasty and 35 % and 47 % , respectively , for those who had a bilateral or revision arthroplasty . CONCLUSIONS Preoperative use of erythropoietin in conjunction with preoperative autologous donation reduces the need for allogeneic blood transfusion associated with total joint arthroplasty more effectively than does either erythropoietin or preoperative autologous donation alone A prospect i ve study was undertaken to assess the efficacy and financial cost of the use of an autologous blood transfusion device in the reduction of allogeneic blood requirements of patients undergoing primary unilateral total knee arthroplasty . Forty-nine consecutive patients received either the CellTrans blood salvage device ( group A of 32 patients ) or the Redivac high vacuum drainage system ( group B of 17 patients ) . The preoperative and postoperative haemoglobin levels were recorded at 72 or 96 hours . Nine percent of group A patients received an allogeneic blood transfusion compared to 59 % in group B. There was an average saving of 1.1 unit of allogeneic blood per patient in group A ( p<0.001 ) . The total cost per patient was about Euro 111 less for the group A patients . Autologous re-infusion was found in this study to be an effective method of reducing allogeneic blood requirements and to afford significant cost savings in primary unilateral knee arthroplasty Two groups of patients having primary or revision total hip replacement were studied during a period of 11 months . The first group of 40 consecutive patients consented to have whole blood collected coincident with acute normovolemic hemodilution . An inventory of autologous red blood cells , plasma , and platelets was prepared in the operating room as a preliminary to surgery . Subsequently , the same supplies and equipment were used for autotransfusion intraoperatively . In a case-control study , another 40 patients having total hip replacements were matched for age , gender , and weight . The second group of patients refused hemodilution and received autotransfusion alone . The perioperative transfusion requirements of the two groups were compared . The total blood product donor exposure rate of the first group was ¼ of the controls ( 0.6 and 2.4 donor units per patient , respectively ) . The average length of stay in the hospital after surgery for the first group was shortened significantly ( 6.2 versus 8.4 days ) , possibly from less immunogenic insult associated with increased transfusions of autologous blood products . Hemodilution , followed by autotransfusion , was cost effective in primary and revision total hip replacements , autotransfusion alone was cost effective only in revision arthroplasty BACKGROUND There are few data on the associations between anaemia , allogeneic blood transfusion ( ABT ) , patient blood management , and outcome after arthroplasty in the UK . National agencies nevertheless instruct NHS Trusts to implement blood conservation measures including preoperative anaemia management . Internationally , blood management programmes show encouraging results . METHODS We retrospectively audited 717 primary hip or knee arthroplasties in a UK general hospital and conducted regression analyses to identify outcome predictors . We used these data to modify previously published algorithms for UK practice and audited its introduction prospect ively . The retrospective audit group served as a control . RESULTS Preoperative haemoglobin ( Hb ) concentration predicted ABT ( odds ratio 0.25 per 1 g dl(-1 ) , P<0.001 ) . It also predicted the length of stay ( LOS , effect size -0.7 days per 1 g dl(-1 ) , P=0.004 ) independently of ABT , including in non-anaemic patients . Patient blood management implementation was associated with lower ABT rates for hip ( 23 - 7 % , P<0.001 ) and knee ( 7 - 0 % , P=0.001 ) arthroplasty . LOS for total hip replacement and total knee replacement decreased from 6 ( 5 - 8 ) days to 5 ( 3 - 7 ) and 4 ( 3 - 6 ) days , respectively , after algorithm implementation ( P<0.001 ) . The all-cause re-admission rate within 90 days decreased from 13.5 % ( 97/717 ) before to 8.2 % ( 23/281 ) after algorithm implementation ( P=0.02 ) . CONCLUSIONS We conclude that preoperative Hb predicts markers of arthroplasty outcome in UK practice . A systematic approach to optimize Hb mass before arthroplasty and limit Hb loss perioperatively was associated with improved outcome up to 90 days after discharge BACKGROUND Allogeneic blood transfusions are associated with a number of well-recognized risks and complications . Postoperative retransfusion of filtered shed blood is an alternative to ( reduce ) allogeneic blood transfusion . The objectives of this study were to evaluate the clinical efficacy of retransfusion of filtered shed blood and to evaluate the complications , in particular febrile reactions . STUDY DESIGN AND METHODS In this clinical trial 160 patients undergoing primary total hip or knee replacement were r and omly assigned to receive either a retransfusion system ( Bellovac , AstraTech AB ) or a regular drain ( Abdovac , AstraTech AB ) . Patients with a preoperative hemoglobin ( Hb ) level of between 13.0 and 14.6 g per dL were included . The shed blood was returned 6 hours after operation . After surgery the anesthesiologist determined the transfusion trigger . When Hb level dropped below this trigger , an  allogeneic blood transfusion  was given . The following data were obtained : number of allogeneic blood transfusions , total volume of blood collected in the bag used for retransfusion , perioperative Hb levels , febrile reaction , and other complications . RESULTS In the control group 19 percent of the patients received at least one allogeneic blood transfusion . In the study group this percentage was 6 percent of the patients ( p = 0.015 ) . Comparing total knee and total hip arthroplasty ( control vs. study ) the percentages were , respectively , 16 percent versus 2 percent ( p = 0.040 ) and 21 percent versus 11 percent ( NS ) . On average 308 mL of filtered shed blood was retransfused in the study group . In the study group 18 percent of patients had febrile reactions compared to 20 percent in the control group . CONCLUSION Postoperative retransfusion of filtered shed blood is effective for decreasing allogeneic blood transfusions after total hip and knee arthroplasty . There was no relationship between retransfusions and postoperative febrile reactions BACKGROUND The value of acute normovolemic hemodilution ( ANH ) as compared to preoperative autologous blood donation ( PABD ) in orthopedic surgery is unknown . Therefore , a prospect i ve , r and omized study was conducted to compare these techniques in patients undergoing primary total hip arthroplasty . STUDY DESIGN AND METHODS ANH patients underwent phlebotomy for up to 3 units , or to a target Hct level of 28 percent  after induction of anesthesia . PABD patients were asked to donate up to 3 units before admission . RESULTS Mean baseline Hct levels were not different in ANH and PABD patients ( 39 . 7 + /- 4.5 vs. 41.8 + /- 3.8 % , p = 0.09 ) . No difference was found in allogeneic blood exposure among ANH and PABD cohorts : 4 ( 17 % ) of 23 ANH patients received a total of 9 allogeneic blood units , compared to no allogeneic transfusions in the PABD cohort ( p = 0.30 ) . Total blood costs associated with ANH were significantly ( p<0.05 ) lower than blood costs associated with PABD ( $ 151 + /- 154 vs. $ 680 + /- 253 , respectively ) . CONCLUSION In patients undergoing total hip arthroplasty , ANH is safe , can be considered equivalent to PABD in effectively reducing exposure to allogeneic RBCs , and is less costly than PABD We have prospect ively evaluated the efficacy of an individualized pre-operative blood saving protocol in elective total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) . The primary aim was to obtain a pre-operative haemoglobin ( Hb ) level of > or = 14 g dL(-1 ) . A reduction in requirements for allogeneic transfusion was considered the second aim . Several strategies are available for increasing pre-operative Hb levels and reducing red blood cell ( RBC ) transfusions following THA or TKA , but the success of these programmes depends on selecting the most appropriate treatment for each patient . Three hundred and five patients with an indication of elective THA or TKA were individually assigned to the following strategies according to Hb and ferritin levels and medical conditions : ( a ) no pre-operative intervention , ( b ) oral iron therapy , ( c ) intravenous ( i.v . ) iron therapy , ( d ) recombinant human erythropoietin alpha with i.v . iron and ( e ) pre-operative autologous donation ( PAD ) plus oral iron . Eighty-two percent of the patients reached a pre-operative Hb level of > or = 14 g dL(-1 ) compared with 62 % of patients with Hb levels of > or = 14 g dL(-1 ) at the baseline visit . Treatment with PAD showed a significant reduction in the pre-operative Hb levels . The rate of RBC transfusion was 18.8 % compared with 31.5 % of matched historic group ( P < 0.001 ) . In conclusion , all patients scheduled to undergo THA or TKA should be c and i date s for an individualized pre-operative blood salvage programme In a prospect i ve , r and omized study of the efficacy and effects of autologous blood transfusion in revision hip arthroplasty , 30 patients were r and omly allocated into two groups . The Control Group received homologous blood transfusion . The Study Group deposited 2 - 3 units of blood preoperatively , intraoperative blood salvage was used , and no homologous blood was transfused intraoperatively . There was a smaller postoperative blood loss in the Study Group . The preoperative hemoglobin values were lower in the Study Group , but one week postoperatively they were higher than in the Control Group . The decrease in the values of AT III and protein C was lower in the Study Group . The combination of preoperative blood donation and intraoperative blood salvage reduced blood loss and homologous blood transfusion in revision hip arthroplasty The efficacy of an integrated autotransfusion regimen , including pre-donation and perioperative salvage of autologous blood , was prospect ively evaluated in 2884 patients undergoing total hip ( n = 2016 ) or knee arthroplasty ( n = 480 ) , and hip revision ( n = 388 ) with either balanced general , regional , or integrated epidural/general anaesthesia .  Allogenic concentrated red blood cells were transfused in the presence of symptomatic anaemia or when haemoglobin concentration was < 6 g dL-1 ( 10 g dL-1 in patients affected by cerebrovascular or coronary artery disease ) after all salvaged and pre-donated autologous blood had been transfused . A total of 278 patients ( 9.6 % ) received allogenic blood . Risk factors for allogenic blood transfusion were : preoperative haemoglobin concentration < 10 g dL-1 ( after autologous blood pre-donations ) ( Odds ratio : 8.7 ; 95 % CI : 6.5 - 16.8 ; P = 0.004 ) , hip revision versus hip or knee arthroplasty ( Odds ratio : 5.8 ; 95 % CI : 3.9 - 8.5 ; P = 0 . 0001 ) and inability in obtaining the number of pre-donations required by the Maximum Surgery Blood Order on Schedule ( Odds ratio : 3.4 ; 95 % CI : 2.7 - 4.1 ; P = 0.0001 ) . The incidence of perioperative complications , including wound infection and haematoma , as well as myocardial ischaemia , respiratory failure and thromboembolic complications , was higher in those patients requiring allogenic blood transfusion ( 29.8 % ) than that observed in patients receiving only autologous blood ( 6.6 % ) ( P = 0.0005 ) ; while the mean time duration from surgical procedure to patient discharge from the orthopaedic ward was shorter in those patients not receiving allogenic blood transfusion ( 12 days ; 25 - 75th percentiles : 8 - 14 days ) than in those patients who required perioperative transfusion with allogenic blood ( 15 days ; 25 - 75th percentiles : 10 - 17 days ) ( P = 0.0005 ) . In conclusion , this prospect i ve study highlighted the clinical relevance of applying an extensive and integrated autotransfusion regimen in order to reduce allogenic blood transfusion and associated complications in patients undergoing major joint replacement
Findings and Conclusion To our knowledge , this is the first meta- analysis to compare the clinical results between PAT and a control in joint replacement patients .
This meta- analysis has proven that the use of a PAT reinfusion system reduced significantly the dem and for ABT , the number of patients who require ABT and the cost of hospitalization after total knee and hip arthroplasty .
This study , together with other previously published data , suggests that PAT drains are beneficial .
Background Total hip or knee arthroplasty is an elective procedure that is usually accompanied by substantial blood loss , which may lead to acute anemia .
As a result , almost half of total joint arthroplasty patients receive allogeneic blood transfusions ( ABT ) .
Many studies have shown that post-operative auto-transfusion ( PAT ) significantly reduces the need for  ABT  , but other studies have question ed the efficacy of this method .