Medical and Economic Advantages of Postoperative Blood Salvage in Total Knee Replacement

Total knee replacement surgery causes large blood loss leading to worsening of the patient's physical capacity, difficulties in rehabilitation and necessity of transfusions. The re-infusion of drainage fluid has been described as an alternative way to improve hematological parameters. The aim of the study was to determine the effectiveness of re-transfusion with regard to the allogeneic transfusion rate, duration of treatment and costs.

We performed a prospective randomized study of 101 patients, divided into an RTF group for re-transfusion from the drain and a DRN group for standard drainage. We could not re-transfuse drainage blood in 6 cases. 38 patients (RTF2) received their blood back and the remaining 63 patients (DRN2) did not. Depending on blood loss, laboratory tests and general condition, decisions were made to proceed with allogeneic transfusions.

In spite of the re-transfusion, 39.4% of the patients in RTF2 required an additional transfusion, compared to 53.9% of the patients in DRN2 (p=0.15). Mean deterioration in hematological parameters was 72.9% of baseline in RTF2 and 75.0% in DRN2 (p=0.45), mean treatment time was 10.3 days for RTF2 and 11.1 for DRN2 (p=0,24) and mean cost was PLN 5426.5 in RTF versus PLN 5587.21 in DRN (p=0.76).

The effect of re-transfusion on reducing allogeneic blood usage is not significant, does not alter patients' general condition and lab test results and does not eliminate the need for transfusion or influence the duration of hospital stay and the costs.