INTRA-OPERATIVE USE OF CELL-SAVER DEVICE DOES NOT DECREASE POSTOPERATIVE TRANSFUSION REQUIREMENTS

Abstract

Total hip-joint arthroplasty is associated with a high rate of perioperative blood transfusion, which increases the risk of blood-borne disease, anaphylactic and haemolytic reactions. Devices are used which collect and allow the re-infusion of blood lost during surgery, with the aim of reducing allogenic blood transfusion requirements. The purpose of this study was to establish whether the use of a ‘cell-saver’ device reduces the risk of post-operative allogenic blood transfusion in total hip joint arthroplasty.

All total hip arthroplasties performed by a single surgeon over a twelve month period were divided into two cohorts of patients; one which used an intra-operative cell saver device, the other which did not. Data was collected for patient demographics, pre-operative blood tests and blood loss, with the outcome measure as post-operative transfusion requirements. The total number of patients was 233; 166 primaries, 33 resurfacing & 20 revision arthroplasties: 14 excluded for insufficient data.

Comparison of the two cohorts (intra-operative cell saver used vs. no cell-saver used), demonstrated no significant difference in the post operative blood transfusion requirements for patients undergoing primary total hip joint arthroplasty (n=166, 18.3% vs. 11.0%, p=0.08), Birmingham resurfacing arthroplasty (n=33, 5% vs. 7.7%, p=0.49), and revision arthroplasty (n=20, 28.6% vs. 50%, p=0.26). There were no significant differences demonstrated between the patient demographics of the two cohorts for any of the groups. In the cell-saver cohort, the average volume of blood re-transfused was 117mls per patient (range 0 – 400mls).

Intra-operative use of cell-saver devices does not decrease post-operative transfusion requirements in primary hip arthroplasty. A larger size study is required to assess the outcome in resurfacing and revision hip arthroplasty surgery.