An increase in cardiopulmonary complications was noted in our patients undergoing knee replacement surgery. These included primarily unexplained dyspnea, unexplained hypoxemia, pulmonary embolism, and cardiac arrhythmias. There was concern that a reinfusion device might be responsible for these increased complications. These devices take aspirated material from the surgical field and reinfuses it into the patient. Aggregate data was analyzed comparing complication rates and transfusion rates with and without use of the device.
Utilizing Premier's Care Science Quality Manager web based analytic tool we compared the risk adjusted complication rates with and without use of the device in all patients hospitalized for total knee replacement over a one year period from July, 2007 until June, 2008. Since these devices are typically used to reduce the need for autologous blood tranfusions postoperatively, we also compared rates of blood production utilization in both groups.
Risk adjusted complication rate with the device was 15.8% above predicted compared to 1.5% above predicted in the non device group significant to the 95% confidence level. See figure 1. The complications in the device group compared to the non device group included cardiac complications in 6.4% vs 1.8%, pulmonary embolism in 5.1% vs 1.2%, other pulmonary complications in 3.8% vs 1.2%. See figure 2. Transfusion were given to 52% of patients in the device group and only 27% of patients in the non device group.
The simple reinfusion device produced an unacceptably high rate of cardiopulmonary complications without reducing the need for autologous blood transfusion. The increased transfusion rate in the device group may be related to treatment of the additional cardiopulmonary complications, especially cardiac.
Use of a simple reinfusion device for knee replacement surgery should be discouraged.
Martin Forrest, No Financial Disclosure Information; No Product/Research Disclosure Information