Does fibrin sealant use in total knee replacement reduce transfusion rates? A non-randomised comparative study

Background: Studies assessing fibrin sealants use during total knee replacement (TKR) have produced inconsistent results. We evaluated fibrin sealant therapy in TKR procedures performed without tourniquet and without postoperative drains. Hypothesis: Use of a fibrin sealant during TKR decreases calculated total blood loss, thereby diminishing blood transfusion requirements and costs. Patients and methods: We studied 62 patients with primary knee osteoarthritis who underwent TKR by the same surgeon between September 2009 and December 2010. Fibrin sealant was used only in the last 31 patients, who were compared to the first 31 patients regarding calculated total blood loss, blood transfusion rate, and mean number of red-blood-cell units used per patient. Costs were compared in the two groups. Results: In the control group, mean total blood loss calculated using the method of Gross was 1.3 +/- 0.6 L, 48% of patients required blood transfusions, and the mean number of units per patient was 0.9 +/- 1. In the fibrin-sealant group, 29% of patients required blood transfusions and the mean number of units was 0.6 +/- 0.9. The between-group differences in favour of the fibrin-sealant group were not statistically significant. In each group, compared with patients not requiring blood transfusions, patients needing transfusions had significantly lower starting preoperative haemoglobin values and a significantly greater positive difference between the calculated total blood loss and the maximum allowable blood loss. In the test group, the cost of the 31 units of fibrin sealant was 9743 (sic) and the cost reduction due to using 11 fewer red-blood-cell units was only 3484 (sic). Hospital stay was not significantly shorter in any of the two groups. Discussion: Blood transfusion minimisation during TKR should rely chiefly on correcting preoperative anaemia and optimizing transfusion decisions based on the difference between the total blood loss and the maximum allowable blood loss. Fibrin sealant did not significantly diminish transfusion requirements in our study. Randomised studies in larger patient populations are needed. The cost of fibrin sealant may exceed the expected cost savings in relation with decreased blood transfusion requirements. Level of evidence: Level III (before-after therapeutic study). (C) 2012 Elsevier Masson SAS. All rights reserved.