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Blood products: optimal use, conservation, and safety
Instructional Course Lectures
|January 1, 1990
Summary
Cell saver use is not cost-effective for routine primary hip or knee replacement. It is recommended for revision surgeries after ruling out infection, with autologous blood donation as a standard alternative.
Area of Science:
- Orthopedic Surgery
- Transfusion Medicine
Background:
- Cell saver (intraoperative blood salvage) is a method to reinfuse a patient's own blood lost during surgery.
- Cost-effectiveness and optimal utilization of cell saver in total joint arthroplasty remain areas of investigation.
Purpose of the Study:
- To evaluate the cost-effectiveness and appropriate indications for cell saver use in primary and revision hip and knee arthroplasty.
- To establish guidelines for autologous blood management in joint replacement surgeries.
Main Methods:
- Retrospective review of total joint arthroplasty cases.
- Analysis of cell saver utilization, cost-effectiveness, and outcomes.
- Assessment of preoperative autologous donation (PAD) and intraoperative blood management strategies.
Main Results:
- Cell saver was found to be not cost-effective for routine primary hip or knee replacement.
- Recommended use of cell saver for revision hip and knee surgery after infection is ruled out via preoperative aspiration.
- Predonation (PAD) is recommended for all hip replacements; 2 units for primary, minimum 3 units for first revision, and maximum possible for complex revisions.
Conclusions:
- Restrict cell saver use to specific revision arthroplasty cases where infection is excluded.
- Preoperative aspiration is crucial for infection screening before cell saver use.
- Autologous blood management, including PAD and careful surgical technique to minimize blood loss, is essential for optimizing patient outcomes and resource utilization.