Postoperative autotransfusion drain after total hip arthroplasty: a meta-analysis of randomized controlled trials

Total hip arthroplasty (THA) is accompanied by substantial blood loss, averaging 1,000–2,000 ml1,2,3 and a decline of 3.0 to 4.0 g/dl in haemoglobin levels3. Moreover, hidden blood loss can account for 60% of total blood loss, ranging from 612 to 1,603 ml4. This substantial blood loss potentially contributes to delayed postoperative rehabilitation, a longer hospital stay, and even mortality. Thus, patients undergoing THA typically require transfusion. However, with an increased awareness of the potential deleterious effects of allogenic blood transfusion, including infection, transfusion-associated lung injury and circulatory overload, and mortality5,6,7,8,9,10, a consensus has emerged on perioperative blood management that allogenic blood transfusion should be minimized. Nevertheless, the rate of allogenic blood transfusions remains high due to the growing number of THA procedures1,11. Saleh et al. stated that the increase in allogenic transfusion is associated with increased complications, longer hospital stays, and increased cost. Thus, they recommended the effective utilization of blood conservation methods1. Autologous blood transfusion, including preoperative autologous blood donation, intraoperative blood salvage and postoperative autotransfusion drain (PATD), is considered effective in reducing allogenic blood transfusion and its underlying risks9,12,13. In several autologous transfusions, PATD is considered relatively simple to implement and potentially cost-effective14,15. Such drainage devices collect postoperatively shed blood and then retransfuse the shed blood (washed or unwashed) to patients within 6 hours postoperatively. Previous studies have demonstrated that PATD significantly reduces the rate of allogenic transfusion and results in reduced blood loss16,17,18,19,20. However, the use of the PATD remains controversial, and some studies have questioned its effectivenss21,22,23,24,25. To resolve the existing uncertainties, we performed a meta-analysis to evaluate the efficacy and safety of PATD compared with a closed-suction drain (CSD).