| objetive: Arthroplasty is an effective operative method to treat hip and knee end stage disease,and the amount of the operation is increased with the increase of the incidence of the disease.But as an elective surgery,the anemia and the allogeneic blood transfusion are common in the perioperative period,now the Erythropoietin has been used in orthopedics patients who underwent total hip or total knee arthroplasty to reduce allogeneic blood transfusion(ABT)and elevated hemoglobin level according to the relevant literature reports.The purpose of this Meta-Analysis is to evaluate the efficacy and safety of the preoperative administration of Erythropoietin to elevate hemoglobin level postoperative and reduce frequency of allogeneic blood transfusion in patients who undergoing total hip or tatal knee arthroplasty.Methods : Two reviewers independently retrieval published literature from PubMed,EMBASE,Cochrane Library,China national knowledge infrastructure(CNKI),VIP,Wanfang database which the time from inception to May 2016.According to the inclusion and exclusion criteria(Inclusion criteria:1.Clinical controlled trials.2.The object of study is the patients who were treated with total hip arthroplasty and total knee arthroplasty.3.The results of the study includes the amount of blood transfusion after operation,postoperative blood transfusion rate,postoperative hemoglobin and the incidence of the deep venous thrombosis.Exclusion criteria:1.Repeated publication;2.The data of the publication is not complete,the outcome is not clear;3.The error of the statistical method is not provide date or can not be converted into OR,RR and its 95% confidence interval,the measurement data can not provide the mean and standard deviation;4.Abstract and full text are not Chinese or English).A total of 13 studies were included,and the following data which were extracted from the study according to the prepare designed method.The date include:1.The author of the literature,the year of the publication and title;2.The object of the research includes:the number of trials and the basal hemoglobin level;3.Intervention measures;4.The dosage of the Erythropoietin and the blood transfusion index;5.The postoperative mean hemoglobin of the patients who undergo total hip arthroplasty or total knee arthroplasty,the number of the patients of the blood transfusion and the number of the patients of the deep venous thrombosis after operation.In accordance with the inclusion and exclusion criteria of the clinical randomized controlled study in accordance with the Handbook for Cochrane Systematic Reviews of Interventions 5.1.0 quality evaluation criteria for evaluation.The patients who received any dose of Erythropoietin therapy were defined as the experimental group,and the patients who were given preoperative autologous blood transfusion or placebo were defined as the control group in the literature which were included in the study.Postoperative hemoglobin is indicated by weighted mean difference and 95% confidence intervals between the experimental group and the control group;the postoperative blood transfusion rate and the deep vein thrombosis rate of the patients are indicated by the relative risk ratio and 95% confidence intervals,the heterogeneity between the studies using I2 and ?2test,the research results stability evaluated by the sensitivity analysis.Publication bias evaluated by the Begg's test and Egger's test.Use RevMan5.3 software for meta-analysis.Results: A total of 2689 patients were included in the 13 articles,the meta analysis showed that the use of the erythropoietin preoperative reduce the allogeneic blood transfusion in patients who undergoing total hip or total knee arthroplasty [RR:0.48,95% CI:(0.36,0.64),P<0.0001].Hemoglobin mean difference between the EPO group and the control group was 10.47(g/L)[95% CI:(8.33,,12.62),P<0.00001].There was no difference in the risk of the deep venous thromboembolism between the EPO group and the control groups[RD:0,95% CI:(-0.01-0.01),P=0.90].The 13 articles included in the study were classified according to the GRADE,6 of them were high quality,and the others were medium quality.Publication bias test was performed on 13 articles which were included in the study and the publication bias test using State13.0 software to evaluate.Begg's test P=0.807 and Egger's test P=0.968,there was no significant publication bias.The sensitivity analysis showed that the stability of the study was good.Conclusion: Erythropoietin improves postoperative hemoglobin levels and decreases the need for allogeneic blood transfusion in patients who undergoing total hip or total knee arthroplasty.There was no difference in the risk of deep vein thrombosis between the EPO group and the control group. |
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