The impact of putting a surgical drain in total knee arthroplasty on the postoperative hemoglobin level
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20253409Keywords:
Blood loss, Hemoglobin, Postoperative care, Suction drainage, Total knee arthroplastyAbstract
Background: The use of suction drains following total knee arthroplasty (TKA) remains controversial, with conflicting evidence regarding their impact on postoperative blood loss and hemoglobin levels.1 To evaluate the impact of closed negative suction drainage on postoperative hemoglobin levels following primary unilateral total knee arthroplasty.
Methods: A retrospective cohort study was conducted involving 102 patients who underwent primary unilateral TKA. Patients were divided into two equal groups: 51 with closed suction drainage and 51 without drainage. Hemoglobin levels were measured preoperatively and 24 hours postoperatively. Statistical analysis was performed using SPSS with appropriate tests for continuous and categorical variables.
Results: No significant difference was observed in the hemoglobin drop between the drain group (1.1±0.6 g/dl) and the no-drain group (1.3±0.8 g/dl) (p=0.142). Both groups showed comparable preoperative hemoglobin levels and postoperative outcomes.
Conclusions: Closed negative suction drainage does not significantly impact postoperative hemoglobin levels within the first 24 hours following total knee arthroplasty, suggesting that routine drain use may not be essential for blood conservation in this patient population.
Metrics
References
Agarwala S, Mohrir G. Are drains required after simultaneous bilateral total knee arthroplasty. J Orthop Surg. 2018;26(3):1-5.
Kia C, Selby R, Warth L, Mont MA. The effect of surgical drains on blood loss and transfusion rates in total knee arthroplasty: A meta-analysis. J Arthroplasty. 2018;33(3):720-8.
Sehat KR, Evans R, Newman JH. Hidden blood loss following hip and knee arthroplasty: Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br. 2000;82(4):561-5.
Good L, Peterson E, Lisander B. Postoperative blood loss in total knee arthroplasty: Effects of tourniquet release. Acta Orthop Scand. 2003;74(5):559-66.
Sehat KR, Evans R, Newman JH. Blood loss after knee arthroplasty: Effects of tourniquet and tranexamic acid. J Bone Joint Surg Br. 2004;86(5):767-70. DOI: https://doi.org/10.1302/0301-620X.86B4.14508
Smith TO, Hing CB. Does a tourniquet reduce blood loss in TKA. Knee. 2010;17(2):141-7. DOI: https://doi.org/10.1016/j.knee.2009.06.007
Esler CN, Blakeway C, Fiddian NJ. The influence of a closed-suction drain on blood loss after total knee arthroplasty. J Bone Joint Surg Br. 2003;85(2):215-7. DOI: https://doi.org/10.1302/0301-620X.85B2.13357
Parker MJ, Livingstone V, Clifton R, McKee A. Closed suction drainage after hip arthroplasty: A meta-analysis. J Bone Joint Surg Am. 2004;86(6):1146-52. DOI: https://doi.org/10.2106/00004623-200406000-00005
Parker MJ, Roberts CP. Closed suction drainage for hip and knee arthroplasty. Cochrane Database Syst Rev. 2017;(7):1825.
Kim YH, Cho SH, Kim RS. Drainage versus non-drainage in TKA: A randomized controlled trial. Clin Orthop Relat Res. 2014;472(5):1587-92.
Worland RL, Jessup DE, Clelland C. Drainage and infection risk in total knee arthroplasty. Orthopedics. 1998;21(4):447-9.
Adalberth G, Bystrom S, Kolstad K, Mallmin H, Milbrink J. Does a drain reduce the risk of infection after knee arthroplasty. J Bone Joint Surg Br. 1998;80(5):894-7.
Murphy PG, Scott DJ. Postoperative drain use in total knee arthroplasty: A meta-analysis. J Arthroplasty. 2007;22(6):915-9.
Nadler SB, Hidalgo JU, Bloch T. Prediction of blood volume in surgical patients. Surgery. 1962;51(2):224-32.
Confalonieri N, Manzotti A, Pullen C. Comparison of drainage versus non-drainage in TKA. Knee. 2001;8(4):307-11.
Andersen KV, Husted H, Kristensen BB, Kehlet H. Closed suction drainage after knee arthroplasty may be unnecessary. Acta Orthop. 2009;80(5):557-63.
Zhou K, Ling T, Wang H, Zhou Z, Pei F. To drain or not to drain in total knee arthroplasty: A meta-analysis. Int J Surg. 2017;39:95-105.
Wang D, Wang HY, Luo ZY, Pei FX, Zhou ZK, Zeng WN. Drainage versus no drainage after total knee arthroplasty: Meta-analysis. PLoS One. 2016;11(7):157271.
Li N, Tan Y, Deng Y, Chen L. The use of suction drainage in total knee arthroplasty: A meta-analysis. Int J Surg. 2014;12(4):408-15.
Pour AE, Parvizi J, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Drainage in total joint arthroplasty: Evidence-based review. J Surg Orthop Adv. 2011;20(1):19-23.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision knee arthroplasty in the United States. J Bone Joint Surg Am. 2007;89(4):780-5. DOI: https://doi.org/10.2106/JBJS.F.00222
Milman N. Anemia-Still a major health problem in many parts of the world. Ann Hematol. 2011;90(4):369-77. DOI: https://doi.org/10.1007/s00277-010-1144-5
Thompson SA. Age-related changes in perioperative care: Implications for blood management. Geriatr Orthop Surg Rehabil. 2015;6(3):191-6.