22. Overview of results: Orthopaedic (knee).
| Outcome |
Total [95% CI] |
Subgroup: blood salvage (collection time) | Subgroup: transfusion threshold | ||||
| Intraoperative | Postoperative | Both | No transfusion threshold | Liberal threshold (Hb > 80 g/L) | Restrictive threshold (Hb ≦ 80 g/L) | ||
| Risk of transfusion |
RR 0.49 [0.37, 0.66] 21 RCTs, N = 2214 ⨁◯◯◯ |
RR 0.45 [0.32, 0.63] 20 RCTs, N = 1939 ⨁◯◯◯ |
RR 0.82 [0.67, 1.01] * 2 RCTs, N = 275 ⨁⨁◯◯ |
RR 0.16 [0.02, 1.32] 3 RCTs, N = 238 ⨁◯◯◯ |
RR 0.44 [0.29, 0.64] 12 RCTs, N = 1142 ⨁◯◯◯ |
RR 0.81 [0.65, 1.01] * 6 RCTS, N = 834 ⨁⨁◯◯ |
|
| Volume transfused (PPR) |
MD ‐0.87 [‐1.09, ‐0.64] 5 RCTs, N = 563 ⨁⨁◯◯ |
MD ‐0.84 [‐1.13, ‐0.55] 5 RCTs, N = 428 ⨁⨁◯◯ |
MD ‐0.93 [‐1.29, ‐0.57] 1 RCTs, N = 135 ⨁⨁◯◯ |
MD ‐0.87 [‐1.09, ‐0.64] 5 RCTS, N = 563 ⨁⨁◯◯ |
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| Volume transfused (PPT) |
MD ‐0.54 [‐0.90, ‐0.19] 3 RCTs, N = 221 ⨁◯◯◯ |
MD ‐0.37 [‐0.81, 0.07] RCTs, N = 130 ⨁◯◯◯ |
MD ‐0.89 [‐1.16, ‐0.62] 1 RCT, N = 91 ⨁⨁◯◯ |
MD ‐0.54 [‐0.90, ‐0.19] 3 RCTs, N = 221 ⨁◯◯◯ |
|||
| All‐cause mortality | |||||||
| Blood loss | MD ‐79.01 [‐170.27, 12.24] 9 RCTs, N = 629 ⨁⨁◯◯ |
MD ‐79.01 [‐170.27, 12.24] 9 RCTs, N = 629 ⨁⨁◯◯ |
MD 5.00 [‐219.16, 229.16] 1 RCT, N = 70 ⨁◯◯◯ |
MD ‐56.24 [‐175.85, 63.37] 6 RCTs, N = 344 ⨁⨁⨁◯ |
MD ‐200.89 [‐384.06, ‐17.72] 2 RCTs, N = 215 ⨁⨁⨁◯ |
||
| Re‐operation | RD 0.00 [‐0.02, 0.02] 1 RCT, N = 178 ⨁◯◯◯ |
RD 0.00 [‐0.02, 0.02] 1 RCT, N = 178 ⨁◯◯◯ |
RD 0.00 [‐0.02, 0.02] 1 RCT, N = 178 ⨁◯◯◯ |
||||
| Infection | POR 0.74 [0.28, 1.94] 5 RCTS, N = 730 ⨁◯◯◯ |
POR 0.86 [0.29, 2.52] 5 RCTS, N = 595 ⨁◯◯◯ |
POR 0.43 [0.05, 3.57] 1 RCT, N = 135 ⨁◯◯◯ |
POR 0.35 [0.05, 2.61] 1 RCT, N = 70 ⨁◯◯◯ |
POR 0.70 [0.17, 2.77] 2RCTs, N = 360 ⨁◯◯◯ |
POR 1.52 [0.25, 9.08] 2 RCTs, N = 300 ⨁◯◯◯ |
|
| Wound complication | POR 1.42 [0.61, 3.31] 6 RCTs, N = 734 ⨁◯◯◯ |
POR 1.42 [0.61, 3.31] 6 RCTs, N = 734 ⨁◯◯◯ |
POR 1.15 [0.41, 3.19] 4 RCTs, N = 356 ⨁◯◯◯ |
POR 2.27 [0.50, 10.24] 2 RCTs, N = 378 ⨁◯◯◯ |
|||
| PJI | RD 0.00 [‐0.01, 0.01] 4 RCTs, N = 663 ⨁◯◯◯ |
RD 0.00 [‐0.01, 0.01] 4 RCTs, N = 528 ⨁◯◯◯ |
RD 0.00 [‐0.03, 0.03] 1 RCT, N = 135 ⨁◯◯◯ |
RD 0.00 [‐0.03, 0.03] 1 RCT, N = 248 ⨁◯◯◯ |
RD 0.00 [‐0.02, 0.02] 3 RCTs, N = 415 ⨁◯◯◯ |
||
| VTE/thrombosis | |||||||
| DVT | POR 1.29 [0.56, 2.95] 9 RCTs, N = 793 ⨁◯◯◯ |
POR 1.29 [0.56, 2.95] 9 RCTs, N = 793 ⨁◯◯◯ |
Not estimable (zero cases) 1 RCT, N = 70 ⨁⨁◯◯ |
POR 1.50 [0.62, 3.65] 6 RCTs, N = 462 ⨁◯◯◯ |
POR 0.48 [0.05, 4.64] 2 RCTs, N = 293 ⨁◯◯◯ |
||
| PE | POR 0.51 [0.10, 2.52] 6 RCTs, N = 574 ⨁◯◯◯ |
POR 0.51 [0.10, 2.52] 6 RCTs, N = 574 ⨁◯◯◯ |
POR 0.30 [0.05, 1.73] 5 RCTs, N = 459 ⨁◯◯◯ |
POR 7.02 [0.14, 354.40] 1 RCT, N = 115 ⨁◯◯◯ |
|||
| MACE | RD 0.00 [‐0.03, 0.03] 1 RCT, N = 112 ⨁⨁◯◯ |
RD 0.00 [‐0.03, 0.03] 1 RCT, N = 112 ⨁⨁◯◯ |
RD 0.00 [‐0.03, 0.03] 1 RCT, N = 112 ⨁⨁◯◯ |
||||
| MI | POR 7.02 [0.14, 354.40] 1 RCT, N = 115 ⨁◯◯◯ |
POR 7.02 [0.14, 354.40] 1 RCT, N = 115 ⨁◯◯◯ |
POR 7.02 [0.14, 354.40] 1 RCT, N = 115 ⨁◯◯◯ |
||||
| CVA/stroke | RD 0.00 [‐0.06, 0.06] 1 RCT, N = 60 ⨁⨁◯◯ |
RD 0.00 [‐0.06, 0.06] 1 RCT, N = 60 ⨁⨁◯◯ |
RD 0.00 [‐0.06, 0.06] 1 RCT, N = 60 ⨁⨁◯◯ |
||||
| Hospital LOS | MD ‐0.79 [‐2.30, 0.72] 4 RCTs, N = 255 ⨁◯◯◯ |
MD ‐0.79 [‐2.30, 0.72] 4 RCTs, N = 255 ⨁◯◯◯ |
MD ‐2.60 [‐4.76, ‐0.44] 1 RCT, N = 70 ⨁⨁◯◯ |
MD ‐0.28 [‐1.59, 1.03] 3 RCTs, N = 185 ⨁⨁◯◯ |
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One study reporting for orthopaedic (knee) reported data for more than one collection period, and so appears in more than one subgroup for timing: Blatsoukas 2010 (postoperative only, and both).
Bolded data highlights where there was a clear intervention effect.
* neared an intervention effect (touched the line of no effect)
"Volume" refers to mean transfusion volume; "transfusions" refers to number of people receiving an allogeneic transfusion
CI: confidence interval; CVA: cerebrovascular accident; DVT: deep vein thrombosis; Hb: haemoglobin; LOS: hospital length of stay; MACE: major adverse cardiovascular events; MD: mean difference; MI: myocardial infarction; N: number of people analysed; PE: pulmonary embolism; PJI: prosthetic joint infection; POR: Peto odds ratio; PPR: per person randomised; PPT: per person transfused; RCT: randomised controlled trial; RD: risk difference; RR: risk ratio; VTE: venous thromboembolism
⨁◯◯◯ = Very low certainty; ⨁⨁◯◯ = Low certainty; ⨁⨁⨁◯ = Moderate certainty; ⨁⨁⨁⨁ = High certainty