Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

Abstract

Background: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Aims: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Study Design: Retrospective comparative study. Methods: Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. Results: No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05) and cost was higher in Group 1 (p<0.05). Conclusion: Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.

Keywords

• Cell saver system, cost, total knee arthroplasty

Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

Öz

References

1. Cushner F, Lee G-C, Scuderi G, Arsht S, Scott WN. Blood loss management in high-risk patients undergoing total knee arthroplasty: a comparison of two techniques. J Knee Surg 2006;19:249-53. [CrossRef]
2. Rees JE, Jeavons R, Dixon JH. An economic justification for autologous blood re-infusion in primary total knee replacement surgery. Ann R Coll Surg Engl 2005;87:102-5. [CrossRef]
3. Sinclair K, Clarke H, Noble B. Blood management in total knee arthroplasty: a comparison of techniques. Orthopedics 2009;32:19. [CrossRef]
4. Lee DH, Padhy D, Lee SH, Kim TK, Choi J, Han SB. Shed blood re-transfusion provides no benefit in computer-assisted primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011;19:926-31. [CrossRef]
5. Moonen AFCM, Neal TD, Pilot P. Peri-operative blood management in elective orthopaedic surgery. A critical review of the literature. Injury 2006;37(Suppl 5):11-6. [CrossRef]
6. Murray DJ, Gress K, Weinstein SL. Coagulopathy after reinfusion of autologous scavenged red blood cells. Anesth Analg 1992;75:125-9. [CrossRef]
7. Kandel L, Vasili C, Kirsh G. Extramedullary femoral alignment instrumentation reduces blood loss after uncemented otal knee arthroplasty. J Knee Surg 2006;19:256-8. [CrossRef]
8. Kirkos J, Krystallis C, Konstantinidis P, Papavasiliou K, Kyrkos M, Ikonomidis L. Postoperative re-perfusion of drained blood in patients undergoing total knee arthroplasty: is it effective and cost-efficient? Acta Orthop Belg 2006;72:18-23.

9. Moonen AFCM, Thomassen BJW, van Os JJ, Verburg AD, Pilot P. Retransfusion of filtered shed blood in everyday orthopaedic practice. Transfus Med 2008;18:355-9. [CrossRef]
10. Moonen AFCM, Knoors N, van Os J, Verburg A, Pilot P. Retransfusion of filtered shed blood in primary total hip and knee arthroplasty: a prospective randomized clinical trial. Transfusion 2007;47:379-84. [CrossRef]
11. Martin A, von Strempel A. Transfusion of autologous blood from reinfusion systems in total knee arthroplasty. Int Orthop 2006;30:541-544. [CrossRef] Abuzakuk T, Kumar VS, Shenava Y, Bulstrode C, Skinner JA, Cannon SR, et al. Autotransfusion drains in total knee replacement. Are they alternatives to homologous transfusion? Int Orthop 2007;31:235-9. [CrossRef]
12. Glynn A, McCarthy T, McCarroll M, Murray P. A prospective audit of blood usage post primary total knee arthroplasty. Acta Orthop Belg 2006;72:24-8.
13. Jones H, Savage L, White C, Goddard R, Lumley H, Kashif F, et al. Postoperative autologous blood salvage drains—are they useful in primary uncemented hip and knee arthroplasty? A prospective study of 186 cases. Acta Orthop Belg 2004;70:466-73.
14. Jain R, Jain S. Blood salvage in total hip and knee arthroplasty in a community hospital: a retrospective study. J Orthop Surg 2005;13:19-26.
15. Strmper D, Weber EWG, Gielen-Wijffels S, Van Drumpt R, Bulstra S, Slappendel R, Durieux ME, Marcus MAE. Clinical efficacy of postoperative autologous transfusion of filtered shed blood in hip and knee arthroplasty. Transfusion 2004;44:1567-71. [CrossRef]
16. Prasad N, Padmanabhan V, Mullaji A. Blood loss in total knee arthroplasty: an analysis of risk factors. Int Orthop 2007;31:39-44. [CrossRef]
17. Southern EP, Huo MH, Mehta JR, Keggi KJ. Unwashed wound drainage blood. What are we giving our patients? Clin Orthop Relat Res 1995;320:235-46.
18. Handel M, Winkler J, Hrnlein RF, Northoff H, Heeg P, Teschner M, et al. Increased interleukin-6 in collected drainage blood after total knee arthroplasty: an association with febrile reactions during retransfusion. Acta Orthop Scand 2001;72:270-2. [CrossRef]
19. Carless P, Moxey A, O’Connell D, Henry D. Autologous transfusion techniques: a systematic review of their efficacy. Transfus Med 2004;14:123-44. [CrossRef]
20. Attaran S, McIlroy D, Fabri BM, Pullan MD. The use of cell salvage in routine cardiac surgery is ineffective and not cost-effective and should be reserved for selected cases. Interact Cardiovasc Thorac Surg 2011;12:824-6. [CrossRef]
21. Reitman CA, Watters WC 3rd, Sassard WR. The Cell Saver in adult lumbar fusion surgery: a cost-benefit outcomes study. Spine (Phila Pa 1976) 2005;29:1580-3. [CrossRef]