Reinfusion Drains in primary total hip arthroplasty

Introduction: Primary total hip replacement can result in a considerable amount of blood loss. Higher pre-operative and post-operative hemoglobin (Hb) levels are related to earlier functional recovery, higher patient satisfaction and shorter hospital length of stay. A number of strategies to reduce the need for blood transfusion have been employed such as retransfusion drains. Objectives: The goal of the study was to evaluate the effects of reinfusion drains on hematological parameters of patients undergoing total hip arthroplasty (THA). Methods: We retrospectively reviewed 103 patients (reinfusion group) who underwent THA with the use of a postoperative reinfusion drain and 100 patients (no reinfusion group) who underwent THA with no postoperative reinfusion drain used. Preoperative variables evaluated were: age, sex and body mass index (BMI); comorbidities; and type of anesthesia. Postoperative variables evaluated were: Hb, hematocrit (Hct) and platelets (Plt) levels at the first, second, third, and fourth postoperative days and at discharge. We also assessed the total blood loss during the postoperative in-hospital stay and the number of units of blood eventually transfused. Results: Eighty-four (84%) patients in the reinfusion group and 42 patients (40.8%) in the no reinfusion group were transfused with at least one unit of blood postoperatively (1.3 ± 0.9 and 0.5 ± 0.7; p<0.001, respectively). The need for transfusion was found to be 7 times higher in the no reinfusion group compared to the reinfusion group. In the first and second postoperative day, Hb levels were higher in the reinfusion group (p = 0.002 and p<0.001, respectively). Hct levels were significantly higher in the reinfusion group at first, second, third and fourth postoperative days and at discharge. No other statistically significant differences were detected. Conclusions: Proper management of patients undergoing THA using reinfusion drains can reduce or eliminate the need for transfusions.