Wound Drainage With or Without Blood Salvage? An Open, Prospective, Randomized and Single-Center Comparison of Blood Loss, Postoperative Hemoglobin Levels and Allogeneic Blood Transfusions After Major Hip Surgery

Robert Slappendel, MD, PhD; Wieger Horstmann, MD; Ris Dirksen, MD, PhD; Gijs G. Van Hellemondt, MD

Disclosures

Transfusion Alter Transfusion Med. 2008;10(4):174-181. 

In This Article

Summary and Background and Study Objectives

Summary

The objectives of the study were to compare an autologous blood salvage low-vacuum drainage system with a high-vacuum drainage system with regard to blood loss, postoperative hemoglobin levels and need for allogeneic transfusion. The study was an open, randomized, prospective and single-center trial. Two hundred patients scheduled for revision total hip surgery were randomized to either the Bellovac ABT (autologous blood salvage, low vacuum) or the Medinorm AG (high vacuum) drainage system. Blood loss, transfusion volumes and hemoglobin levels were measured during the whole postoperative period. No statistically significant differences were detected between the two drainage systems with regard to transfusion rate, blood loss and adverse events. The hemoglobin decrease during the first postoperative day was statistically significantly less in the Bellovac ABT group (P = 0.0111). Postoperative hemoglobin concentrations were found to be higher in the Bellovac ABT group compared with the Medinorm group at day 1. In addition, the Bellovac ABT system offers a possibility of transfusion of postoperatively salvaged blood that may decrease the need for allogeneic blood transfusion.

Background and Study Objectives

High-vacuum drainage systems (pressure of 300-600 mmHg) have long been the dominant product in the area of postoperative drainages. In recent years, many countries and hospitals have gone over more and more from high-vacuum systems to low-vacuum drainage (pressure of 20-150 mmHg) to reduce the risk of tissue damage, minimize pain on catheter removal and also possibly reduce requirements for allogeneic blood transfusion. One other method available to reduce the need of allogeneic transfusion requirements is autologous blood salvage and reinfusion. For example, Bellovac ABT (Astra Tech AB, Mölndal, Sweden) is a system with double functionality that enables collection of autologous blood for reinfusion during the first 6 hours after surgery, in addition to the low-vacuum wound drain function used in total hip and knee surgery. The reinfusion of the shed blood collected in a drain can be transfused to the patient without any preparations at the surgical unit, and efficacy, in terms of a reduced need for allogeneic blood transfusion, has been demonstrated in total knee and hip surgery.[1,2,3,4,5,6,7,8]

The objectives of the study were to investigate and compare clinical benefits and efficacy of an autologous blood salvage low-vacuum drainage system and a high-vacuum drainage system with regard to blood loss during the first 24 hours after major revision hip surgery, need for allogeneic blood transfusion and postoperative hemoglobin levels, and to evaluate safety by assessment of adverse events.

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