Abstract
Introduction
There is no established evidence to support the use of drains after total knee replacement; however 94% of orthopaedic surgeons in UK routinely use closed suction drains. Haematomas can form with or without using drains, presence of which in addition may provide portal for infection and may increase blood loss. Blood group and save is routinely performed for every patient undergoing total knee replacement, however actual cross match and transfusion is needed for a small percentage of patients.
Aim
To compare the requirement for blood transfusion after total knee replacement with and without the use of closed suction drains and the cost analysis of performing routine blood group and save pre-operatively.
Materials and Methods
In this retrospective study, we reviewed the data over the last 2 years (2008–2009). Patients were divided into 2 groups (drains versus no drains). 11 surgeons preferred drains and 2 did not use drains. We also compared the results of one particular surgeon who used drains for patients operated in the years 2006 and 2007 and did not use drains in the years 2008 and 2009.
Results
1564 knee replacements were performed by 13 surgeons. 8.1% patients (n=128) received blood transfusion post operatively. In the drainage group (n=1451), 8% patients (n=117) received transfusion. In the non-drainage group (n=113), 9.7% patients (n=11) received transfusion. Comparing the results of one particular surgeon (2006–2007), 5.7% patients (n=5) received transfusion (total n=87 with the use of drains) while 5.3% patients (n=3) operated by the same surgeon (2008–2009) had blood transfusion (total n=56 without using drains).
As only 8.1% patients received blood transfusion, the blood samples for the remaining 91.9% patients remained unused. A single group and save sample currently costs £30.30. This suggests we could potentially save £21,750 per year by selectively performing group and save.
Conclusion
There was no statistically significant difference in blood transfusion requirement in the two groups. In the current financially driven society, we can cut the costs significantly by selectively performing group and save and post operatively, if blood transfusion is indicated clinically, it can be arranged within safe time limit even in the absence of a pre-arranged sample.
