3-h drain clamping is not effective to reduce total blood loss after primary total knowledge
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Purpose: Total knee arthroplasty (TKA) is a clinically efficacious surgical option for end-stage knee osteoarthritis. However, TKA increases the risk of serious bleeding and blood transfusion. The objective of this study was to evaluate the difference in postoperative blood loss in groups subjected to 3 h of clamping and non-clamping and determine the variations in rate and amount of transfusion after TKA between the two groups. Materials and methods: Propensity score matching of the group subjected to 3-h drain clamping (43 patients; September 2015 to April 2016) and the control group (43 patients; before initiating the clamping method) was performed in patients undergoing unilateral primary posterior stabilized TKA. The two groups were compared. We measured the total drained blood volume until the drain was removed 48 h after surgery, and we compared the preoperative levels of hemoglobin and hematocrit with levels observed on days 1 and 2 after surgery. We also determined the blood transfusion rate and volume as well as the occurrence of clamping-associated complications. Results: In the group subjected to 3-h drain clamping, the mean volume of total drained blood was significantly lower than in the control group (333.8 ± 190.2 mL vs. 839.9 ± 339.8 mL, P <0.001). There was no significant difference in total blood loss between the two groups (1226.9 ± 488.1 mL vs. 1127.1 ± 424.5 mL, P = 0.315), but the hidden blood loss was significantly higher in the 3-h drain clamping group than in the control group (893.1 ± 487.7 mL vs. 294.7 ± 531.8 mL, P <0.001). Both the transfusion rate and amount in the 3-h drain clamped group were higher than in the control group but were not statistically significant (30.2% vs. 37.2%, P = 0.494 and 269.8 ± 483.8 mL vs. 316.3 ± 158.2 mL, P = 0.648, respectively). No significant differences in complications, including deep vein thrombosis, pulmonary thromboembolism, and oozing, were noted between the two groups (all, P = 1.000). Conclusions: The 3-h drain clamping method after primary TKA using posterior stabilized implant reduced the loss of postoperative drained blood. However, hidden blood loss was significantly higher in the 3-h drain clamping group; as a result, there were no differences in total blood loss and transfusion rate. The clamping method did not significantly alter the complication rate.
Abstract
Purpose: Total knee arthroplasty (TKA) is a clinically efficacious surgical option for end-stage knee osteoarthritis. However, TKA increases the risk of serious bleeding and blood transfusion. The objective of this study was to evaluate the difference in postoperative blood loss in groups subjected to 3 h of clamping and non-clamping and determine the variations in rate and amount of transfusion after TKA between the two groups. Materials and methods: Propensity score matching of the group subjected to 3-h drain clamping (43 patients; September 2015 to April 2016) and the control group (43 patients; before initiating the clamping method) was performed in patients undergoing unilateral primary posterior stabilized TKA. The two groups were compared. We measured the total drained blood volume until the drain was removed 48 h after surgery, and we compared the preoperative levels of hemoglobin and hematocrit with levels observed on days 1 and 2 after surgery. We also determined the blood transfusion rate and volume as well as the occurrence of clamping-associated complications. Results: In the group subjected to 3-h drain clamping, the mean volume of total drained blood was significantly lower than in the control group (333.8 ± 190.2 mL vs. 839.9 ± 339.8 mL, P <0.001). There was no significant difference in total blood loss between the two groups (1226.9 ± 488.1 mL vs. 1127.1 ± 424.5 mL, P = 0.315), but the hidden blood loss was significantly higher in the 3-h drain clamping group than in the control group (893.1 ± 487.7 mL vs. 294.7 ± 531.8 mL, P <0.001). Both the transfusion rate and amount in the 3-h drain clamped group were higher than in the control group but were not statistically significant (30.2% vs. 37.2%, P = 0.494 and 269.8 ± 483.8 mL vs. 316.3 ± 158.2 mL, P = 0.648, respectively). No significant differences in complications, including deep vein thrombosis, pulmonary thromboembolism, and oozing, were noted between the two groups (all, P = 1.000). Conclusions: The 3-h drain clamping method after primary TKA using posterior stabilized implant reduced the loss of postoperative drained blood. However, hidden blood loss was significantly higher in the 3-h drain clamping group; as a result, there were no differences in total blood loss and transfusion rate. The clamping method did not significantly alter the complication rate.
참고문헌 (23)
- Ritter MA, "Closed wound drainage in total hip or total knee replacement. A prospective, randomized study", J Bone Joint Surg Am, 76(1), pp.35~38 (1994)
- Lotke PA, "Blood loss after total knee replacement. Effects of tourniquet release and continuous passive motion", J Bone Joint Surg Am, 73(7), pp.1037~1040 (1991)
- Callaghan JJ, "Blood management and patient specific transfusion options in total joint replacement surgery", Iowa Orthop J, 20, pp.36~ (2000)
- Canty SJ, "Do we practice evidence based medicine with regard to drain usage in knee arthroplasty? Results of a questionnaire of BASK members", Knee, 10(4), pp.385~387 (2003)
- Esler C, "The use of a closed-suction drain in total knee arthroplasty: a prospective, randomised study", J Bone Joint Surg (Br), 85(2), pp.215~217 (2003)
- Niskanen R, "Drainage is of no use in primary uncomplicated cemented hip and knee arthroplasty for osteoarthritis : a prospective randomized study", J Arthroplast, 15(5), pp.567~569 (2000)
- Parker MJ, "Closed suction drainage for hip and knee arthroplasty : a meta-analysis", J Bone Joint Surg Am, 86(6), pp.1146~1152 (2004)
- Senthil Kumar G, "Rate of blood loss over 48hours following total knee replacement", Knee, 12(4), pp.307~309 (2005)
- Kiely N, "Does temporary clamping of drains following knee arthroplasty reduce blood loss? A randomised controlled trial", Knee, 8(4), pp.325~327 (2001)
- Shen P-C, "Comparison between 4 hour clamping drainage and nonclamping drainage after total knee arthroplasty", J Arthroplast, 20(7), pp.909~913 (2005)
- Stucinskas J, "Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis : a prospective, randomised trial", Int Orthop, 33(5), pp.1275~1278 (2009)
- Gross JB, "Estimating allowable blood loss : corrected for dilution", Anesthesiology, 58, pp.277~280 (1983)
- Jeon YS, "Optimal release timing of temporary drain clamping after total knee arthroplasty", J Orthop Surg Res, 12(1), pp.47~ (2017)
- Frietsch T, "Research for transfusion safety-priority of administration safety", Transfus Apher Sci, 58(6), pp.102650~ (2019)
- Aksoy Y, "The comparison of the effects of intraoperative bleeding control and postoperative drain clamping methods on the postoperative blood loss and the need for transfusion following total knee arthroplasty", Acta Orthop Traumatol Turc, 45(3), pp.190~194 (2011)
- Madadi F, "Comparison of drain clamp after bilateral total knee arthroplasty", J Knee Surg, 23(04), pp.215~222 (2010)
- Prasad N, "Comparison between two methods of drain clamping after total knee arthroplasty", Arch Orthop Trauma Surg, 125(6), pp.381~384 (2005)
- Sa-ngasoongsong P, "Postoperative blood loss reduction in computer-assisted surgery total knee replacement by low dose intra-articular tranexamic acid injection together with 2 hour clamp drain: a prospective triple-blinded randomized controlled trial", Orthop Rev, 3(2) (2011)
- Jung WH, "No difference in total blood loss, haemoglobin and haematocrit between continues and intermittent wound drainage after total knee arthroplasty", Knee Surg Sports Traumatol Arthrosc, 21(12), pp.2831~2836 (2013)
- Sehat K, "Hidden blood loss following hip and knee arthroplasty : correct management of blood loss should take hidden loss into account", J Bone Joint Surg(Br), 86(4), pp.561~565 (2004)
- Tai T-W, "Temporary drainage clamping after total knee arthroplasty : a meta-analysis of randomized controlled trials", J Arthroplast, 25(8), pp.1240~1245 (2010)
- Tai TW, "Non-drainage is better than 4 hour clamping drainage in total knee arthroplasty", Orthopedics, 33(3) (2010)
- Huang Z, "Meta-analysis of temporary versus no clamping in TKA", Orthopedics, 36(7), pp.543~550 (2013)