Abstract
Retrospective. Evaluate the role and effectiveness of ICS in primary posterior spinal fusion (PSF) for idiopathic scoliosis (IS). Intraoperative cell salvage (ICS) minimizes blood loss and need for allogeneic transfusions. However, it adds substantial charges ($800-1200 US) and may be of less clinical benefit in some PSF for IS. This was a single-hospital, retrospective analysis of 178 consecutive IS cases (10-18years of age) who underwent primary PSF by a single pediatric spine surgeon. Overall, 41% of cases received a mean 167cc of ICS blood, after a mean EBL of 528mL (range 200-1800mL). No blood was returned in 59% of cases, with a mean EBL of 293mL (range 75-700mL). Only 6.5% of the entire cohort received > / = 250cc via ICS, after a mean EBL of 773mL. A positive correlation exists between EBL and vertebral levels fused, preoperative major Cobb angle, and length of anesthesia (p < 0.001). ICS may be more efficacious at an inflection point of 12 vertebral fusion levels, preoperative major Cobb angles > / = 55°, anesthesia exposure > / = 6h, and with use of posterior column osteotomies (PCOs) (p < 0.05). In addition, lack of tranexamic acid use lead to greater EBL (p < 0.0001) and ICS volumes (p = 0.008). The use of ICS in IS patients undergoing PSF resulted in the return of > / = 250cc of ICS blood (similar volume to one allogeneic unit) in only 6.5% of cases. Charges for ICS set-up and processing of one bowl of ICS is much higher than for one allogeneic unit ($1200 vs. $462 US), hence transfusing lower volumes of autologous ICS blood is not cost-effective for all PSF for IS. IV; Therapeutic studies.
Published Version
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