Friday, November 1, 2001 4:29–5:12 pm Concurrent Session 4B: Lumbar Fusion—Bone and Blood Allograft Risks: 4:29 Cost–benefit analysis of blood replacement in single-level posterior spinal fusion

Abstract

Purpose of study: This study was undertaken to review our experience with single-level posterior instrumented lumbar fusions in an effort to identify which patients would require blood transfusion (TXF) and to determine the cost effectiveness of using autologous blood predonation (AB) and intraoperative blood salvage (CS).Methods used: Data were collected by means of retrospective chart review. Clinical data included demographics and comorbidities, pre- and postoperative HCT, duration of procedure, EBL, CS collection, number of AB units collected preoperatively, number and source of perioperative units of blood transfused. Financial data included charges for AB (Red Cross plus hospital processing) and hospital charges for CS.of findings: Seventy-nine patients were included. The major difference between patients was the type of concurrent procedure carried out during the surgical setting. Forty procedures were at L4–L5, 23 at L5–S1, 14 at L3–L4 and 2 at L2–L3. Concurrent procedures, in addition to the fusion, were undertaken in 71 cases (90%). AB was used in 53 patients, and CS was used in 71 cases. Sixty-five patients (82%) did not receive postoperative TXF, and females were less likely to require a postoperative TXF (p=.026). Thirteen patients (18%) received a postoperative TXF with older age, shorter height and lower preoperative hematocrit being more likely to require a TXF (p=.001). Overall CS blood was transfused intraoperatively in 44 patients (62%). There was no statistically significant difference in the number of CS units transfused intraoperatively between the patients who required postoperative TXF and those who did not. The charge associated with AB totaled $361 per unit. CS charges totaled $951 per case, regardless of the number of units transfused. In the group requiring postoperative TXF, all 25 units of AB were used totaling $9,025 in charges. In this group CS was used in 11 cases, totaling $10,461 in charges. However, 5 of these patients did not receive any CS TXF ($4,755 in charges). In the group not requiring a postoperative TXF, 62 units of AB had been predonated, with charges totaling $22,382. CS was used in 60 of these patients with a total charge of $57,060. However, 22 patients did not receive any CS TXF ($29,922 in charges). The total charge for AB and CS for all 79 cases was $98,928. The total cost for AB not used and CS without subsequent return was $48,059.Relationship between findings and existing knowledge: Previous reports have varied greatly in their recommendations regarding the use of intraoperative blood salvage and replacement. Likewise, multiple factors have been identified as predictors of postoperative blood TXF.Overall significance of findings: Based on our study, it appears that postoperative TXF may be more likely required in males, patients over 55 years, patients who are shorter stature and in patients with a preoperative hematocrit less than 35. If these criteria could have been applied to our sample of patients preoperatively, we may have saved $22,382 in charges associated in unnecessary predonations of AB. The charge for two units of AB ($722) is still less than the charge for CS ($951), which raises the question of which should be the preferred method of insuring the availability of blood for TXF. Considering our entire cohort, a total savings of $89,903 in charges could have been realized if we would have been able to predict preoperatively which patients would not require/receive their predonated AB. In summary, our study has demonstrated that a selective approach to blood predonation and intraoperative salvage can result in substantial savings in charges associated with single-level posterolateral spinal fusions.Disclosures: No disclosures.Conflict of interest: No conflicts.