Suction drainage increases the need for blood transfusion in bilateral total knee arthroplasty

In simultaneous bilateral total knee arthroplasties (TKA), the blood transfusion rate could be higher, considering the cumulative blood loss from both knees. Due to its continuous suction mechanism, closed drainage can increase the amount of postoperative bleeding and drainage. In this study, we evaluated the effect of suction drain on postoperative blood transfusion in patients undergoing simultaneous bilateral TKA.

Consecutive 400 primary simultaneous bilateral TKAs were studied. In the 'drain group' of 100 consecutive patients (200 TKAs), a suction drain was used, and in the subsequent consecutive 100 patients (200 knees, 'No drain group'), no drain was used. The volume of postoperative suction drainage, hemoglobin, hematocrit, transfusion requirements, and related complications are studied retrospectively. Data was collected using patient case notes, blood bank data, and the laboratory data, which is stored digitally for all the patients in the hospital electronic database.

In the "drain group", the combined mean collection in the suction drain was 527.2 ml (±273.2 ml). The mean post-operative change in the hemoglobin was 2.63 gm/dl (±1.06 gm/dl). There were 31 patients with post-operative hemoglobin below 8 gm/dl requiring 49 units of packed cells transfused.In the No-drain group, the mean post-operative change in hemoglobin was 2.42 gm/dl (±1.005 gm/dl). There were 16 patients with postoperative Hemoglobin below 8 gm/dl requiring 21 pints of packed cells transfusion in this group. The greater drop in the postoperative hemoglobin percentage occurred in the "Drain group", which is statistically significant. The blood transfusions from the two groups yielded a p-value of 0.0057, which is also statistically significant.

Our study concludes that no drainage in primary simultaneous bilateral TKA may reduce the need for blood transfusions compared to the closed suction drain.