Abstract
Background. The use and effectiveness of intraoperative cell salvage has been analyzed in many surgical specialties. Until now, no data exist evaluating the efficacy of intraoperative cell salvage in cerebral aneurysm surgery. Aim. To evaluate the efficacy and cost effectiveness of intraoperative cell salvage in cerebral aneurysm surgery. Methods. Data were collected retrospectively for all the patients who underwent cerebral aneurysm surgery at our institution between 2013 and 2019. Routinely, we apply blood salvage through autotransfusion. The cases were divided into a ruptured cerebral aneurysm group and a unruptured cerebral aneurysm group. Results. A total of 241 patients underwent cerebral aneurysm clipping. Of all the cerebral aneurysms, 116 were ruptured and 125 were unruptured and clipped electively. Age, location of the aneurysm, postoperative red blood cell count, intraoperative blood loss, and number of allogenic blood cell transfusions were statistically significantly different between the groups. The autotransfusion of salvaged blood could only be facilitated in eight cases with ruptured cerebral aneurysms and in none with unruptured cerebral aneurysms clipped electively (p < 0.01). Additionally, 35 patients with ruptured cerebral aneurysms and one patient with unruptured cerebral aneurysm required allogenic red blood cell transfusion after surgery, and 71 vs. 2 units of blood were transfused (p < 0.0001). In terms of cost effectiveness, a total of EUR 45,189 in 241 patients was spent to run the autotransfusion system, while EUR 13,797 was spent for allogenic blood transfusion. Conclusions. The use of cell salvage in patients with unruptured cerebral aneurysm, undergoing elective surgery, is not effective.
Highlights
Intraoperative cell salvage is widely used in many surgical specialties
Some studies report the advantage of using cell salvage in spine surgery, little evidence exists to support the use of intraoperative cell salvage in intracranial surgical procedures [7,8,9,10,11]
The patients harboring an unruptured cerebral aneurysm were significantly younger compared to the patients undergoing cerebral aneurysm repair after subarachnoid hemorrhage (p = 0.03)
Summary
Cell salvage seems to be efficacious in reducing the need for allogeneic red blood cell (RBC) transfusion in adults, and in pediatric elective surgical procedures [1,2,3,4,5,6]. Cohort studies including all types of neurosurgical procedures have reported rates of allogeneic transfusion ranging between 10 and 45% [12,13,14]. The rate of transfusion varies depending on the procedure, from 10% in complex skull base neurosurgical procedures to 36% in patients with TBI, and as high as 45% in pediatric craniosynostosis surgery [13,15,16,17]. In patients undergoing open neurosurgical intervention for intracranial aneurysm, the occurrence of major intraoperative morbidity and complications was an independent risk factor for perioperative red blood cell (RBC) transfusion [18]
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