10:58 73. Intraoperative Cell Saver Does Not Decrease Postoperative Blood Transfusion in Instrumented Lumbar Fusion Patients

Abstract

BACKGROUND CONTEXT: The use of blood products in the treatment of postoperative anemia continues to pose risks of allergic reactions, hemolytic reactions, isoimmunization, graft versus host reactions, increased infection rates, and transmission of blood-borne pathogens. Although our previous study has shown that autologous blood donations can help limit and decrease the chances of requiring additional allogeneic blood, it still did not completely eliminate the risk of further allogeneic blood transfusions. Because posterior lumbar fusion surgery can be associated with major intraoperative blood loss, the use of intraoperative cell saver (CS) has been advocated as a means of further decreasing the postoperative allogeneic transfusion requirements in these lumbar fusion patients. However, some studies have questioned the effectiveness of cell saver in elective lumbar fusion surgery, and furthermore, it is unknown if it can actually decrease allogeneic blood usage in patients who also predonated autologous blood. PURPOSE: The purpose of this study was to determine whether there was a significant decrease in the number of allogeneic postoperative blood transfusions when intraoperative CS was used. STUDY DESIGN/SETTING: The hospital charts and operating room records of 240 instrumented lumbar fusion patients were retrospectively reviewed. Patients underwent the operative procedure and were admitted at the senior author’s institution. PATIENT SAMPLE: The subject population included all patients undergoing elective instrumented posterior lumbar spinal fusions. The patients ranged in age from 36 to 85. All patients were treated by the senior author. OUTCOME MEASURES: The primary outcome measures were the number of PRBC transfused in the postoperative period and hematocrit at discharge. METHODS: The patients underwent posterior lumbar fusion using a standard posterior approach, segmental pedicle screw fixation, and postero-lateral decortication with bone grafting. Intraoperative CS was used in 141 patients compared with 99 control patients. Data collected included estimated blood loss, cell saver re-infused, preand postoperative hemoglobin and hematocrit, and units of packed red blood cells (PRBC) transfused. RESULTS: Postoperative transfusion requirements were higher in the CS group versus the non-CS group, however this difference was not statistically significant (2.7 vs. 2.3, p 5 .091). There was no statistical difference for discharge hematocrit between the CS and non-CS groups (28.7 vs. 28, p5.06) (Fig. 1). CONCLUSIONS: In this series of 240 instrumented posterior lumbar fusion patients, use of intraoperative cell saver did not decrease the number of postoperative allogeneic blood transfusions, and did not result in an increased hematocrit at discharge. These results suggest that the use of intraoperative cell saver may not be beneficial for use in elective instrumented posterior lumbar spinal fusion surgery as an adjunct to preoperative autologous blood donation. FDA DEVICE/DRUG STATUS: Cell Saver: Approved for this indication. CONFLICT OF INTEREST: No conflicts.