There is no benefit of blood salvage during or after total knee or hip replacement surgery for patients with pre-operative Hb over 13 g/dL.

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• Cynthia So-Osman, Rob G H H Nelissen, Ankie W M M Koopman-van Gemert, Ewoud Kluyver, Ruud G Pöll, Ron Onstenk, Joost A Van Hilten, Thekla M Jansen-Werkhoven, Wilbert B van den Hout, Ronald Brand, and Anneke Brand.
• From the Department Center of Clinical Transfusion Research, Sanquin Blood Supply, Leiden, The Netherlands (C.S.-O., J.A.V.H., and A.B.); Department of Orthopedic Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands (R.G.H.H.N.); Department of Anaesthesiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands (A.W.M.M.K.-v.G.); Department of Anaesthesiology, Slotervaart Hospital, Amsterdam, The Netherlands (E.K.); Department of Orthopedic Surgery, Slotervaart Hospital, and VU University Medical Center, Amsterdam, The Netherlands (R.G.P.); Department of Orthopedic Surgery, Groene Hart Hospital, Gouda, The Netherlands (R.O.); Department of Medical Statistics and BioInformatics, LUMC, Leiden, The Netherlands (T.M.J.-W. and R.B.); Department of Medical Decision Making, LUMC, Leiden, The Netherlands (W.B.v.d.H.); and Department of Immunohaematology and Blood Transfusion Service, LUMC, Leiden, The Netherlands (A.B.).
• Anesthesiology. 2014 Apr 1;120(4):852-60.

BackgroundPatient blood management is introduced as a new concept that involves the combined use of transfusion alternatives. In elective adult total hip- or knee-replacement surgery patients, the authors conducted a large randomized study on the integrated use of erythropoietin, cell saver, and/or postoperative drain reinfusion devices (DRAIN) to evaluate allogeneic erythrocyte use, while applying a restrictive transfusion threshold. Patients with a preoperative hemoglobin level greater than 13 g/dl were ineligible for erythropoietin and evaluated for the effect of autologous blood reinfusion.MethodsPatients were randomized between autologous reinfusion by cell saver or DRAIN or no blood salvage device. Primary outcomes were mean intra- and postoperative erythrocyte use and proportion of transfused patients (transfusion rate). Secondary outcome was cost-effectiveness.ResultsIn 1,759 evaluated total hip- and knee-replacement surgery patients, the mean erythrocyte use was 0.19 (SD, 0.9) erythrocyte units/patient in the autologous group (n = 1,061) and 0.22 (0.9) erythrocyte units/patient in the control group (n = 698) (P = 0.64). The transfusion rate was 7.7% in the autologous group compared with 8.3% in the control group (P = 0.19). No difference in erythrocyte use was found between cell saver and DRAIN groups. Costs were increased by €298 per patient (95% CI, 76 to 520).ConclusionIn patients with preoperative hemoglobin levels greater than 13 g/dl, autologous intra- and postoperative blood salvage devices were not effective as transfusion alternatives: use of these devices did not reduce erythrocyte use and increased costs.

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