Summary of findings 9. Cell salvage compared to no cell salvage in orthopaedic (mixed) surgeries.
| Cell salvage compared to no cell salvage in orthopaedic (mixed) surgeries | ||||||
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Patient or population: orthopaedic (mixed) Setting: hospital Intervention: cell salvage Comparison: no cell salvage | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no cell salvage | Risk with cell salvage | |||||
| Transfusions (during hospital stay) | 163 per 1000 | 104 per 1000 (73 to 146) | RR 0.64 (0.45 to 0.90) | 4011 (11 RCTs) | ⨁◯◯◯ Very lowa,b | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on allogeneic transfusion risk |
| Volume of transfusion (units) (PPT) (during hospital stay) | The mean volume of transfusion (units) (PPT) ranged from 1.3 to 2.65 units | MD 0.24 lower (0.73 lower to 0.24 higher) | ‐ | 395 (5 RCTs) | ⨁◯◯◯ Very lowc,d,e | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on the volume of transfusion required PPT |
| Mortality (up to 90 days) | 0 per 1000 | 0 per 1000 (0 to 0) | RD 0.00 (‐0.07 to 0.07) | 69 (1 RCT) | ⨁◯◯◯ Very lowf | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on mortality risk |
| DVT (up to 90 days) | 3 per 1000 | 1 per 1000 (0 to 6) | OR 0.41 (0.09 to 1.92)g | 3295 (4 RCTs) | ⨁⨁◯◯ Lowh | There may be no difference between cell salvage use and no cell salvage use for DVT risk |
| Infection (up to 90 days) | 0 per 1000 | 0 per 1000 (0 to 0) | RD 0.00 (‐0.02 to 0.02) | 239 (1 RCT) | ⨁◯◯◯ Very lowa,i | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on infection risk |
| MI (up to 90 days) | 4 per 1000 | 3 per 1000 (1 to 10) | OR 0.62 (0.17 to 2.22)g | 3017 (2 RCTs) | ⨁◯◯◯ Very lowj | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on MI risk |
| CVA (stroke) (up to 90 days) ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No data were available for this outcome |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; CVA: cerebrovascular accident; DVT: deep vein thrombosis; MD: mean difference; MI: myocardial infarction; MID: minimally important difference; OIS: optimal information size; POR: Peto odds ratio; PPT: per person transfused; RD: risk difference; ROB: risk of bias; RR: risk ratio; SD: standard deviation | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded twice for ROB due to unclear risk in most domains and high risk in blinding domain bDowngraded once for inconsistency: I2 = 72%, moderate to high heterogeneity cDowngraded once for ROB due to unclear and low risk in most domains, but with high risk for randomisation in one study and high risk for blinding in one study dDowngraded twice for inconsistency: I2 = 75%, moderate to high heterogeneity eDowngraded once for imprecision as CI crosses one MID boundary (MID calculated as +/‐0.5*SD in control group = +/‐0.5*0.96) fDowngraded three times for imprecision as sample size is far below OIS for this outcome gPeto OR used due to low event rate in both groups (< 5%) hDowngraded twice for imprecision as CI crosses both MID boundaries (0.8 to 1.25) iDowngraded once for imprecision as sample size is below OIS for this outcome jDowngraded three times for imprecision: very wide confidence intervals