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Effects of disusing closed suction drainage in simultaneous bilateral total hip arthroplasty: A retrospective cohort
Chan-Woo Park1, Seung-Jae Lim1, Insun Yoo1
1Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Discontinuing closed suction drainage (CSD) in cementless simultaneous bilateral total hip arthroplasty (SBTHA) significantly reduces blood loss and the need for transfusions. This practice does not increase pain or wound complications when tranexamic acid is used.
Area of Science:
- Orthopedic Surgery
- Surgical Innovation
- Patient Blood Management
Background:
- Simultaneous bilateral total hip arthroplasty (SBTHA) is associated with significant postoperative blood loss.
- Closed suction drainage (CSD) has been a traditional method to manage blood loss in hip arthroplasty.
- Minimizing blood loss and transfusion requirements are critical in optimizing patient outcomes after SBTHA.
Purpose of the Study:
- To evaluate the impact of omitting closed suction drainage (CSD) on postoperative blood loss.
- To assess the effect of disusing CSD on transfusion rates in cementless SBTHA.
- To compare pain scores, complication rates, and implant survivorship between SBTHA with and without CSD.
Main Methods:
- Retrospective cohort study of cementless SBTHAs performed between January 2014 and March 2017.
- Comparison of outcomes between patients who underwent SBTHA with CSD and those without CSD.
- All patients received intravenous tranexamic acid (TXA); outcomes analyzed included hemoglobin drop, blood loss, transfusion rates, pain, complications, and implant survivorship.
Main Results:
- Patients without CSD experienced significantly lower hemoglobin drop (3.9 vs. 4.8 g/dL), calculated blood loss (1190 vs. 1530 mL), and transfusion rates (21.9% vs. 45.7%).
- Length of hospital stay was also shorter in the group without CSD (5.8 vs. 6.6 days).
- No significant differences were observed in postoperative pain, wound complications, Harris Hip scores, or 4-year implant survivorship.
Conclusions:
- Omitting CSD in cementless SBTHA, when combined with intravenous TXA, effectively reduces postoperative blood loss and transfusion requirements.
- This approach does not compromise patient comfort, surgical site integrity, or long-term implant performance.
- Discontinuation of CSD represents a safe and effective strategy for blood management in SBTHA.
Purpose:
Increased blood loss remains a major drawback of simultaneous bilateral total hip arthroplasty (SBTHA). We examined the effects of disusing closed suction drainage (CSD) on postoperative blood loss and transfusion requirement in cementless SBTHA.
Methods:
A retrospective cohort study was conducted with a consecutive series of cementless SBTHAs performed by a single surgeon between January 2014 and March 2017. The surgeon routinely used CSD until May 2015 and refrained from CSD in all primary THAs thereafter. This study included SBTHAs with intravenous administration of tranexamic acid (TXA). Postoperative hemoglobin drop, blood loss, transfusion rate, pain scores, complication rates, and implant survivorships were compared between the groups of SBTHA with and without CSD. The minimum follow-up duration was 1 year.
Results:
Among the 110 patients (220 hips), 46 (92 hips) and 64 (128 hips) underwent SBTHA with and without CSD, respectively. Maximum hemoglobin drop (mean, 4.8 vs. 3.9 g/dL; P = 0.001), calculated blood loss (mean, 1530 vs. 1190 mL; P<0.001), transfusion rate (45.7% vs. 21.9%; P = 0.008), and length of hospital stay (mean, 6.6 vs. 5.8 days; P = 0.004) were significantly lower in patients without CSD. There were no significant differences in postoperative pain scales and wound complication rates. The mean Harris Hip scores at final follow-up (92.5 vs. 92.1; P = 0.775) and implant survivorships with an end-point of any revision at 4 years (98.9% vs. 98.4%; log-rank, P = 0.766) were similar between groups.
Conclusions:
Disusing CSD significantly reduced postoperative blood loss and transfusion requirement without increasing postoperative pain and surgical wound complications in cementless SBTHA with concurrent administration of intravenous TXA.
