Background: Patients undergoing total hip
replacement routinely receive perioperative blood transfusions,
increasing their risk of blood-borne disease, isoimmunization, anaphylactic
reaction, and hemolytic reaction. The purpose of this retrospective,
case-control study was to evaluate the effect of postoperative blood
salvage on the need for allogeneic transfusion following total hip replacement.
Methods: We reviewed the medical records of
ninety consecutive patients who, during a twelve-month period, had
undergone unilateral, elective total hip replacement that included
use of a postoperative blood salvage device. For comparison, we
reviewed the medical records of ninety consecutive patients who
had undergone total hip replacement without postoperative blood
salvage. Overall, 156 patients had complete medical records and
were included in the study.
Results: Eight (10 percent) of the patients
who had been treated with a drain and seventeen (23 percent) of the
patients who had been treated without a drain received allogeneic
transfusions. Of the nineteen patients who had not deposited autologous
blood, all six without postoperative blood salvage required allogeneic
transfusion. With control for other variables in the model, regression
analysis showed a significantly increased risk of allogeneic transfusion
among patients who had undergone total hip replacement without postoperative
blood salvage (p = 0.0028) and without having predonated autologous
units (p = 0.0001).
Conclusions: Despite a limited sample size,
the study results showed that postoperative blood salvage significantly
reduced the risk of allogeneic transfusion among patients managed
with total hip replacement, whether or not they had deposited autologous
blood (p < 0.0001). With control for donated units, age, gender,
preoperative hematocrit, intraoperative blood loss, and cementless
technique, patients who were treated without postoperative blood
salvage were approximately ten times more likely to require allogeneic
transfusion than were patients who had a drain.