Intraoperative Cell Salvage for Revision Hip Arthroplasty: A 24-Year Study of Transfusion Requirements.

Background: Revision hip arthroplasty is associated with significant blood loss and a subsequent need for blood transfusion. Intraoperative cell salvage (ICS) is a method of recovering a patient's blood for autologous transfusion. This potentially reduces the need for allogenic blood transfusion (ABT), thus avoiding associated risk and expense. This study assessed the impact of the use of ICS on the need for ABT in revision hip arthroplasty in a tertiary referral center over a 24-year period.

Materials and methods: Retrospective analysis of prospectively collected data of revision hip arthroplasties performed between November 1996 and May 2020 was undertaken. ABT and ICS use for each procedure was collated and analyzed.

Results: Two thousand six hundred thirty-nine revision hip operations were included, of which 755 (28.6%) used ICS. Significantly less patients in the ICS group required ABT, 218 patients (28.9%) compared with 923 (49.0%) in the control group, p < 0.001, χ² test. Patients who had ICS required significantly fewer units of ABT per person (ICS group: 0.73 units/person (554/755, SD 1.4); control group 1.36 units/person (2,574/1884, SD 1.9) (p < 0.001, t-test)).

Discussion: The use of ICS in revision hip surgery significantly reduces the risk of requiring postoperative ABT and reduces the volume of allogenic blood required. This reduces the known risks associated with ABT, with associated cost saving benefits of reduced transfusion rates and reduced use of the precious resource of allogenic blood. We advise the use of ICS in all patients undergoing revision hip surgery and, in particular, those patients with higher bleeding risks outlined in the study.