We also found no significant increase in adverse events related to use of the hemostatic agent. Complications of particular concern would include wound complications, deep prosthesis infection, and systemic thromboembolic disease (eg, myocardial infarction, stroke, DVT, pulmonary embolus). There were no statistical differences in major and minor complications between the groups and no identifiable complications related to the hemostatic agent used.
Our results should be viewed in light of study limitations. First, with this retrospective study, we relied heavily on the accuracy of computer-based patient documentation. In addition, blood loss estimates are imperfect regardless of measurement technique. Intraoperative EBL is often determined by the surgeon and is highly variable, and autologous blood collection does not account for blood lost in operative sponges, instruments, and irrigation. To minimize this issue, we tried to assess perioperative blood loss through multiple data points, including intraoperative EBL, autologous blood returned during surgery, drain output, transfusion rates, and HBL calculations. Also, blood transfusion criteria depend on the physician’s clinical assessment and decision making, as well as patient condition, which could certainly add variability to the transfusion rate between groups. Another limitation is that the procedures studied were not homogeneous, and including primary and revision anatomical and reverse shoulder arthroplasties may have added variability to the results. In this single-surgeon study, however, we were able to ensure that the same standard techniques and hemostasis were applied in all procedures. Last, given the relatively small sample used, more patients may be needed to reveal a significant and clinically relevant difference in blood loss.
Conclusion
Perioperative blood loss poses serious risks to patient health. In light of the varying findings in the literature and the cost of transfusions and blood loss management products, use of these hemostatic agents remains controversial. In the present study, we found no significant difference in perioperative blood loss or transfusion rates with use of a hemostatic agent during shoulder arthroplasty. Therefore, we cannot conclude that this agent is effective for blood loss management in shoulder arthroplasty. Highly powered prospective studies are needed to confirm our findings.