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. 2023 Sep 8;2023(9):CD001888. doi: 10.1002/14651858.CD001888.pub5

8. Overview of included studies (PICO) ‐ Orthopaedic (hip).

Study details Population (surgery type) CS detail Intervention detail Control detail Outcomes reported (time point)
Ayers 1995
RCT 
Registration: N/A 
Country: USA 
N = 232 Orthopaedic (hip) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: No protocol 
System: Autovac postoperative orthopaedic Autotransfusion Canister (Boehringer Labs, Norristown, Pennsylvania) (Cell Saver (Haemonetics, Braintree, Massachusetts) also used in revision cases) Postoperative blood salvage
N = 103 Closed suction (Hemovac) drain (control)
N = 129

  • Transfusions (48 hours postoperative)

  • Volume (NA)

  • Blood loss (NA)
Cheung 2010
RCT 
Registration: Retrospective (18 months) 
Country: UK 
N = 153 Orthopaedic (hip) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: No threshold 
System: Bellovac ABT drain (Astra Tech Ltd., Gloucesteshire, UK) Group 1: reinfusion drain (ABT group)
N = 53 Group 2: suction drain; group 3: no drain
N = 100

  • Transfusions (NR)

  • Volume (NA)

  • Blood loss (NA)

  • Mortality (NR)

  • Re‐operation (NR)

  • Infection (NR)

  • PJI (12 months)

  • Hospital LOS (NA)
Ekback 1995
RCT 
Registration: N/A 
Country: Sweden 
N = 30 Orthopaedic (hip) ‐ arthroplasty Timing of collection: intraoperative 
Washing: washed 
Transfusion threshold: Maintain erythrocyte volume fraction (EVF) > 27% 
System: Haemonetics Cell‐saver 4, Althin model AT I000 or Shiley/Dideco STAT Group 2: autotransfusion
N = 15 Group 1: control, heterologous erythrocyte concentrate
N = 15

  • Volume (intraoperative and 6 hr postoperative)

  • Blood loss (NA)

  • CVA/stroke (7 days)
Elawad 1991
RCT 
Registration: N/A 
Country: Sweden 
N = 40 Orthopaedic (hip) ‐ arthroplasty Timing of collection: intraoperative 
Washing: washed 
Transfusion threshold: Hb < 85 g/L 
System: Electromedic Autotrans, AT‐1000 autotransfusion system (Englewood, CO, U.S.A.). Autologous/cell saver (IAT group)
N = 20 Homologous/control
N = 20

  • Transfusions (postoperative only)

  • Volume (intraoperative and postoperative)

  • Blood loss (intraoperative and postoperative)

  • DVT (postoperative)
Horstmann 2012
RCT 
Registration: No trial registration 
Country: The Netherlands 
N = 100 Orthopaedic (hip) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb 6.4 g/L ASA1; Hb 8 g/dL ASA2/3; Hb 9.6 g/dL ASA4 
System: Bellovac Autologous Blood Transfusion (ABT) Astra Tech, Molndal, Sweden) Autotransfusion
N = 50 No drainage
N = 50

  • Transfusions (in‐hospital)

  • Volume (in‐hospital)

  • Blood loss (NR)

  • Infection (NA)

  • PJI (NA)

  • Wound complication (NA)

  • VTE/thrombosis (3 months)

  • DVT (3 months)

  • PE (3 months)

  • Hospital LOS
Horstmann 2013
RCT 
Registration: No trial registration 
Country: The Netherlands 
N = 204 Orthopaedic (hip) ‐ arthroplasty Timing of collection: both intra‐ and postoperatively
Washing: unwashed 
Transfusion threshold: Hb 6.4 g/L ASA1; Hb 8 g/dL ASA2/3; Hb 9.6 g/dL ASA4 
System: Sangvia, autologous blood salvage machine (low vacuum, 100 to 150 mmHg; Astratech, Mölndal, Sweden) Autologous blood transfusion (ABT) (Autotransfusion)
N = 102 No drainage
N = 102

  • Transfusions (9 days postoperative)

  • Volume (in‐hospital)

  • Blood loss (NR)

  • Infection (NA)

  • PJI (3 months)

  • DVT (3 months)

  • Hospital LOS
Horstmann 2014a
RCT 
Registration: No trial registration 
Country: The Netherlands 
N = 118 Orthopaedic (hip) ‐ arthroplasty Timing of collection: both intra‐ and postoperatively
Washing: unwashed 
Transfusion threshold: Hb 6.4 g/L ASA1; Hb 8 g/dL ASA2/3; Hb 9.6 g/dL ASA4 
System: Sangvia, autologous blood salvage machine (low vacuum, 100 to 150 mmHg; Astratech, Mölndal, Sweden) ABT group (intra‐ and postoperative autotransfusion)
N = 56 Drain group (control) 
N = 62

  • Transfusions (postoperative)

  • Blood loss (NR)

  • Mortality (3 months)

  • Infection (NA)

  • PJI (3 months)

  • Hospital LOS
Kleinert 2012
RCT 
Registration: No trial registration 
Country: Switzerland 
N = 120 Orthopaedic (hip) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 80 g/L 
System: Bellovac Autologous Blood Transfusion (ABT) Astra Tech, Molndal, Sweden) Group C (reinfusion)
N = 40 Group A (no drain) and B (standard drain)
N = 80

  • Transfusions (NR)

  • Infection (NR)

  • Wound complication (NR)

  • Hospital LOS
Lorentz 1991
RCT 
Registration: N/A 
Country: Germany 
N = 31 Orthopaedic (hip) ‐ arthroplasty Timing of collection: both intra and postoperatively
Washing: washed 
Transfusion threshold: Hb < 10 g/dL 
System: Cell Saver III, Fa, Haemonetics Group 3: autotransfusion
N = 16 Group 4: control group
N = 15

  • Transfusions (intraoperative and postoperative)

  • Volume (NA)

  • Blood loss (intraoperative only)
Luo 2016
RCT 
Registration: No trial registration 
Country: China 
N = 91 Orthopaedic (hip) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: No protocol 
System: ConstaVac Blood Conservation II (CBCII, Stryker Instruments, Kalamazoo, Michigan, USA) autologous blood transfusion device ABT Group: Drainage + retransfusion
N = 49 Drain group: drainage only
N = 42

  • Blood loss (intraoperative and postoperative)

  • VTE/thrombosis (7 days postoperative)
Menges 1992
RCT 
Registration: N/A 
Country: Germany 
N = 26 Orthopaedic (hip) ‐ arthroplasty Timing of collection: intraoperative 
Washing: NR 
Transfusion threshold: Hb < 9 g/dL or Hct < 28% 
System: MAT (Autotrans BT 795 P, Dideco, S.p.a., Modena, Italy) Group 2: Autotransfusion
N = 14 Group 1: control 
N = 12

  • Transfusions ("observation period")

  • Volume (NA)

  • Blood loss ("observation period")
Rollo 1995 ‐ ALL
RCT 
Registration: N/A 
Country: USA 
N = 115 Orthopaedic (hip) ‐ arthroplasty Timing of collection: all 
Washing: both 
Transfusion threshold: No threshold 
System: group 1: intra‐ and postoperatively Haemonetics (Braintree, MA); group 2: postoperative Solcotrans (Smith & Nephew Richards, Memphis, TN) Group 1 (Cell Saver) and Group 2 (Solcotrans)
N = 75 Group 3 (Hemovac)
N = 40

  • Transfusions (48 hours)

  • Volume (NA)

  • Blood loss (NA)

  • Infection (NR)

  • PJI (NR)

  • Wound complication (NR)
Rollo 1995 ‐ SUBGROUP both intra‐ and postoperatively
RCT 
Registration: N/A 
Country: USA 
N = 55 Orthopaedic (hip) ‐ arthroplasty Timing of collection: both intra‐ and postoperatively
Washing: washed 
Transfusion threshold: No threshold 
System: Haemonetics, Braintree, MA Group 1 (Cell Saver)
N = 35 Group 3 (Hemovac)
N = 20

  • Transfusions (48 hours)

  • Volume (NA)

  • Blood loss (NA)

  • Infection (NR)

  • PJI (NR)

  • Wound complication (NR)
Rollo 1995 ‐ SUBGROUP postoperative only
RCT 
Registration: N/A 
Country: USA 
N = 60 Orthopaedic (hip) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: No threshold 
System: postoperative: Solcotrans (Smith & Nephew Richards, Memphis, TN) Group 2 (Solcotrans)
N = 40 Group 3 (Hemovac) (Hemovac drain (Zimmer, Warsaw, IN))
N = 20

  • Transfusions (48 hours)

  • Volume (NA)

  • Blood loss (NA)

  • Infection (NR)

  • PJI (NR)

  • Wound complication (NR)
Smith 2007
RCT 
Registration: N/A 
Country: UK 
N = 158 Orthopaedic (hip) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 8 g/dL 
System: ABTrans autologous retransfusion system (Surgical Innovations Ltd, Leeds, UK) Group B: postoperative salvage (ABTrans autologous retransfusion system) 
N = 76 Group A: vacuum drain (two size 12 Medinorm vacuum drains (Van Straten, Quiershied, Germany)
N = 82

  • Transfusions (NR)

  • Volume (NA)

  • Wound complication (6‐8 weeks)

  • Hospital LOS (NA)
Teetzman 2014
RCT 
Registration: Retrospective (3 years) 
Country: Norway 
N = 161 Orthopaedic (hip) ‐ any hip surgery Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: No threshold 
System: Sangvia™ Blood Salvage System Group 1: Autotransfusion of autologous blood
N = 74 Group 2: allotransfusion group (allogeneic blood only)
N = 87

  • Transfusions (NR)

  • Volume (NA)

  • Mortality (in‐hospital)

  • Infection (NR)

  • Hospital LOS (NA)
Thomassen 2012
RCT 
Registration: Prospective 
Country: The Netherlands 
N = 216 Orthopaedic (hip) ‐ arthroplasty Timing of collection: both intra‐ and postoperatively
Washing: unwashed 
Transfusion threshold: Hb < 8.5 g/dL 
System: SangviaTM Blood Management System (Astra Tech AB, Molndal, Sweden) Sangvia
N = 106 control
N = 110

  • Transfusions (NA)

  • Volume (NA)

  • Blood loss (discharge)

  • Mortality (60 days)

  • PJI (60 days)

  • Wound complication (60 days)

  • PE (60 days)
Tripkovic 2008
RCT 
Registration: N/A 
Country: Croatia 
N = 60 Orthopaedic (hip) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 100 g/L or Hct < 30% 
System: BIODREN system, BE.R.CO. s.p.a. (Modena, Italy) Group 1: Reinfusion group
N = 30 Group 2: Control group
N = 30

  • Transfusions (48 hours postoperative)

  • Volume (48 hours)

  • Blood loss (48 hours)
Zhao 2016
RCT 
Registration: No trial registration 
Country: China 
N = 200 Orthopaedic (hip) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 80 g/L 
System: NR Autologous blood transfusion group
N = 127 Negative pressure drainage ball group
N = 73

  • Transfusions (NR)

  • Volume (NA)

  • Blood loss (6 hours)

ANH: acute normovolemic haemodilution; AT: autotransfusion; CABG: cardiopulmonary bypass graft; CS: cell salvage; CVA: cerebrovascular accident; DVT: deep vein thrombosis; Hb: haemoglobin; Hct: haematocrit; LOS: hospital length of stay; MACE: major adverse cardiovascular events; MI: myocardial infarction; N: planned recruitment (as reported by the study); NA: not analysable; NR: not reported; PE: pulmonary embolism; PJI: prosthetic joint infection; RAP: retrograde autologous prime; RCT: randomised controlled trial; VTE: venous thromboembolism

"Registration: N/A" means 'not applicable' as the study was published before 2010
"Volume" refers to mean transfusion volume
"Transfusions" refers to number of people receiving an allogeneic transfusion