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

9. Overview of included studies (PICO) ‐ Orthopaedic (knee).

Study details Population (surgery type) CS detail Intervention detail Control detail Outcomes reported (time point)
Abuzakuk 2007
RCT 
Registration: N/A 
Country: UK 
N = 104 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 9 g/dL 
System: Bellovac Autologous Blood Transfusion System (AstraTech Healthcare, Molndal, Sweden) Autotransfusion drain
N = 52 Standard drain
N = 52

  • Transfusions (24 hours)

  • Volume (NA)

  • Blood loss (24 hours)

  • Wound complication (NR)

  • Hospital LOS
Adalberth 1998
RCT 
Registration: N/A 
Country: Sweden 
N = 49 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb decrease > 30% pre‐op value or < 90 g/L 
System: Solcotrans (Solco Basle UK Ltd) Autotransfusion (Solcotrans) drain
N = 24 Standard (Redon) drain
N = 25

  • Transfusions (24 hours)

  • Volume (24 hours)

  • Blood loss (24 hours)

  • DVT (NR)

  • PE (NR)

  • CVA/stroke (NR)

  • Hospital LOS
Altinel 2007
RCT 
Registration: N/A 
Country: Turkey 
N = 32 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 9 g/dL 
System: ConstaVac CBC II (Stryker, Kalamazoo, MI, USA) Study group
N = 16 Control group
N = 16

  • Volume (24 hours)

  • Blood loss (24 hours)

  • DVT (NR)

  • Hospital LOS
Amin 2008
RCT 
Registration: N/A 
Country: UK 
N = 178 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 8 g/dL 
System: Bellovac ABT autotransfusion system (AstraTech, Mölndal, Sweden) Autologous retransfusion drain
N = 92 Standard vacuum drain
N = 86

  • Transfusions (3 days)

  • Volume (NA)

  • Blood loss (NA)

  • Re‐operation (24 hours)

  • Wound complication (NR)

  • DVT (NR)

  • Hospital LOS (NA)
Blatsoukas 2010 ‐ ALL
RCT 
Registration: No trial registration 
Country: Greece 
N = 248 Orthopaedic (knee) ‐ arthroplasty Timing of collection: all 
Washing: both 
Transfusion threshold: Hb < 10 g/dL 
System: Dideco Compact Advanced (Dideco, 41037, Mirandola, Italy) (intraoperative); ConstaVac CBC II (Stryker, Kalamazoo, MI) (postoperative) Group 1: intra and postoperative autotransfusion; group 2: postoperative only
N = 163 Allogeneic transfusion only
N = 85

  • Transfusions (2 days)

  • Volume (2 days)

  • Infection (3 months)

  • PJI (3 months)
Blatsoukas 2010 ‐ SUBGROUP both intra‐ and postoperatively
RCT 
Registration: No trial registration 
Country: Greece 
N = 135 Orthopaedic (knee) ‐ arthroplasty Timing of collection: both intra‐ and postoperatively
Washing: both 
Transfusion threshold: Hb < 10 g/dL 
System: Dideco Compact Advanced (Dideco, 41037, Mirandola, Italy) (intraoperative); ConstaVac CBC II (Stryker, Kalamazoo, MI) (Post‐op) Group 1: intra‐ and postoperative autotransfusion
N = 92 Allogeneic transfusion only
N = 43

  • Transfusions (2 days)

  • Volume (2 days)

  • Infection (3 months)

  • PJI (3 months)
Blatsoukas 2010 ‐ SUBGROUP post‐op only
RCT 
Registration: No trial registration 
Country: Greece 
N = 113 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 10 g/dL 
System: ConstaVac CBC II (Stryker, Kalamazoo, MI) Group 2: post‐op only
N = 71 Allogeneic transfusion only
N = 42

  • Transfusions (2 days)

  • Volume (2 days)

  • Infection (3 months)

  • PJI (3 months)
Breakwell 2000
RCT 
Registration: N/A 
Country: UK 
N = 33 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 9 g/dL 
System: ConstaVac CBC II (Stryker, Kalamazoo, MI) Group 1 = blood retrieval and autologous transfusion (study group)
N = 14 Group 2 = allogeneic blood only (control group)
N = 19

  • Volume (NA)

  • Blood loss (NA)
Cheng 2005
RCT 
Registration: N/A 
Country: Hong Kong 
N = 60 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 9 g/dL 
System: DONOR (Van Straten Medical, Nieuwegein, the Netherlands), Reinfusion group
N = 26 Control group
N = 34

  • Transfusions (3 days)

  • Volume (NA)

  • Blood loss (NA)

  • DVT (NR)
Cip 2013
RCT 
Registration: No trial registration 
Country: Austria 
N = 151 Orthopaedic (knee) ‐ arthroplasty Timing of collection: both intra‐ and postoperatively
Washing: washed 
Transfusion threshold: Hb < 8 g/dL 
System: OrthoPAT (Haemonetics, Braintree, USA) Group A: autotransfusion
N = 76 Group B: control (regular drain without suction)
N = 75

  • Transfusions (5 days)

  • Volume (NA)

  • Blood loss (NA)
Dramis 2006
RCT 
Registration: N/A 
Country: UK 
N = 49 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 9 g/dL 
System: CellTrans (Summit Medical) reinfusion system Group A: autotransfusion drain
N = 32 Group B: standard vacuum drain)
N = 17

  • Transfusions (48 hours post‐op)

  • Volume (NA)
Dutton 2012
RCT 
Registration: No trial registration 
Country: UK 
N = 48 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: No protocol 
System: Bellovac Autologous Blood Transfusion System (AstraTech Healthcare, Molndal, Sweden) Retransfusion drain
N = 23 No drain 
N = 25

  • Transfusions (NR)

  • Volume (NA)
Heddle 1992
RCT 
Registration: N/A 
Country: Canada 
N = 79 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 90 g/L 
System: Solcotrans (Solco Basle, Inc., Rockland, MA) Solcotrans group
N = 39 Control: Davol suction (Davol, Bard Canada, Mississauga, Ontario, Canada)
N = 40

  • Transfusions (5 days post‐op)

  • Volume (5 days)

  • Blood loss (5 days)

  • DVT (in‐hospital)
Horstmann 2014b
RCT 
Registration: No trial registration 
Country: The Netherlands 
N = 115 Orthopaedic (knee) ‐ 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) Autologous Blood Transfusion (ABT) group
N = 59 No drainage
N = 56

  • Transfusions (NR)

  • Volume (NA)

  • Blood loss (intraoperative)

  • Infection (NA)

  • PJI (3 months)

  • DVT (3 months)

  • PE (3 months)

  • MI (3 months)

  • Hospital LOS (NA)
Kirkos 2006
RCT 
Registration: N/A 
Country: Greece 
N = 155 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 10 g/dL 
System: ‘closed’ system of collection and re‐infusion of blood which contains a 260 micron pre‐filter to prevent air and marrow fatty material from passing through into the transfusion bag Group B: autotransfusion (reinfused within 6 hours)
N = 78 Group A: standard vacuum drains
N = 77

  • Volume (intraoperative and post‐op)

  • PE (24 hours)
Laszczyca 2015
RCT 
Registration: No trial registration 
Country: Poland 
N = 101 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 8 g/dL or fall of > 5 g/dL or Hb < 9 g/dL + symptoms/bleeding 
System: HandyVac (ATS (Unomedical) retransfusion set RTF/RTF2: Drainage + retransfusion
N = 44 DRN/DRN2: drainage only
N = 57

  • Transfusions (NR)

  • Blood loss (NA)

  • Hospital LOS (NA)
Majowski 1991
RCT 
Registration: N/A 
Country: UK 
N = 40 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 9.5 g/dL 
System: Solcotrans® orthopaedic reinfusion system (Solco‐Basle UK Ltd, High Wycombe,
Bucks) Study group: Autotransfusion
N = 20 Control group: Standard drain
N = 20

  • Transfusions (48 hours)

  • Volume (NA)

  • Blood loss (post‐op 48 hours)

  • Wound complication (NR)

  • DVT (NR)
Munteanu 2009
RCT 
Registration: N/A 
Country: Romania 
N = 100 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hct < 24%, Hct < 27% chronic cardiac, Hct < 30% acute cardiac 
System: ConstaVac Stryker (CVAC) Group 3: CVAC (Constavac)
N = 50 Group 1: Control ("Martor")
N = 50

  • Transfusions (perioperative)

  • Volume (NA)

  • Blood loss (NR)

  • Infection (NR)

  • PJI (NR)
NCT 00839241
RCT 
Registration: Retrospective (1 month) 
Country: Poland 
N = 45 Orthopaedic (knee) ‐ arthroplasty Timing of collection: NR 
Washing: unwashed 
Transfusion threshold: No protocol 
System: Bellovac ABT Autologous Blood Transfusion
N = 20 Allogenic Blood Transfusion
N = 25 None reported
Newman 1997
RCT 
Registration: N/A 
Country: UK 
N = 70 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: No threshold 
System: Dideco 797 reinfusion system (Sorin Biomedical UK Ltd, Midhurst, UK) Reinfusion
N = 35 Homologous transfusion
N = 35

  • Transfusions (7 days)

  • Volume (NA)

  • Blood loss (7 days)

  • Infection (7 days)

  • DVT (7 days)

  • Hospital LOS
Pavelescu 2014
RCT 
Registration: No trial registration 
Country: Romania 
N = NR ‐ 78 over 3 groups Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: NR 
Transfusion threshold: Hb < 9 g/dL 
System: NR Group C: reinfusion system drainage at the end of surgery (with TXA)
N = NR ‐ 78 over 3 groups Group B: TXA (IV)
N = NR ‐ 78 over 3 groups

  • Transfusions (NA)

  • Volume (NA)

  • Blood loss (NA)
Rosencher 1994
RCT 
Registration: N/A 
Country: France 
N = 30 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hct < 30% 
System: Orth‐Evac (Deknatel, 600 Airport Road, Fall‐River, MA, USA) or Solcotrans Plus (Solco Basle, Solco HPG, Haighan, MA, USA) Ortho‐Evac group and Solcotrans group
N = 20 Control group (Temoins)
N = 10

  • Transfusions (NR)
Sait 1999
RCT 
Registration: N/A 
Country: UK 
N = 120 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: NR 
Transfusion threshold: No protocol 
System: NR Group 2: blood conservation system
N = 60 Group 1: standard drain
N = 60

  • Transfusions (NR)
Šarkanoviü 2013
RCT 
Registration: No trial registration 
Country: Serbia 
N = 112 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: washed 
Transfusion threshold: Hb < 85 g/L 
System: Hemonetics 5+, USA Group 2 (autologous blood)
N = 55 Group 1 (allogeneic blood)
N = 57

  • Transfusions (NR)

  • Volume (NA)

  • Blood loss (NA)

  • Infection (NR)

  • Wound complication (NR)

  • DVT (NR)

  • PE (NR)

  • MACE (NR)

  • Hospital LOS (NA)
Schnurr 2018
RCT 
Registration: No trial registration 
Country: Germany 
N = 200 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: washed 
Transfusion threshold: Hb < 7 g/dL, Hb < 10 g/dL + symptoms; Hb < 9 g/dL + cardiac, Hb < 10 g/dL + cardiac + symptoms 
System: OrthoPAT (Haemonetics, Braintree, USA) Autologous blood transfusion (ABT) drain
N = 100 Redon group
N = 100

  • Transfusions (7 days)

  • Volume (NA)

  • Blood loss (NA)

  • Infection (42 days)

  • PJI (42 days)

  • Wound complication (42 days)
Shenolikar 1997
RCT 
Registration: N/A 
Country: UK 
N = 100 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: washed 
Transfusion threshold: Hb < 9 g/dL 
System: Haemonetics cell saver 3 machine Autologous group
N = 50 Allogeneic group
N = 50

  • Transfusions (7 days)

  • Volume (NA)

  • Wound complication (3 months)

  • DVT (3 months)

  • PE (3 months)

  • Hospital LOS (NA)
Thomas 2001
RCT 
Registration: N/A 
Country: UK 
N = 231 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: washed 
Transfusion threshold: Hb < 9 g/dL 
System: Cell Saver 5 Haemonetics). Autologous (cell salvage)
N = 115 Allogenic (homologous)
N = 116

  • Transfusions (7 days post‐op)
Touzopoulos 2021
RCT 
Registration: Retrospective (8 months) 
Country: Greece 
N = 40 Orthopaedic (knee) ‐ arthroplasty Timing of collection: postoperative 
Washing: unwashed 
Transfusion threshold: Hb < 9 g/dL 
System: Cell Trans Summit Medical Ltd, Gloucestershire, UK) Group 1: Self‐transfusion
N = 20 Group 2: conventional drain
N = 20

  • Transfusions (post‐op)

  • Volume (NA)

  • Blood loss (intraoperative and post‐op)

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