Abstract
Posterior spinal instrumentation and fusion surgery in school-aged children and adolescents is associated with the potential for massive intraoperative blood loss, which requires significant allogeneic blood transfusion. Until now, the intraoperative use of the cell saver has been extensively adopted; however, its efficacy and cost-effectiveness have not been well established. Therefore, the aim of this study is to determine the efficacy and cost-effectiveness of intraoperative cell saver use. This study was a single-center, retrospective study of 247 school-aged and adolescent patients who underwent posterior spinal instrumentation and fusion surgery between August 2007 and June 2013. A cell saver was used intraoperatively in 67 patients and was not used in 180 patients. Matched case-control pairs were selected using a propensity score to balance potential confounders in baseline characteristics. Allogeneic red blood cell (RBC) and plasma transfusions as well as blood transfusion costs were analyzed. The propensity score matching produced 60 matched pairs. Compared to the control group, the cell saver group had significantly fewer intraoperative allogeneic RBC transfusions (P = 0.012). However, when the combined postoperative and total perioperative periods were evaluated for the use of allogeneic RBC transfusion, no significant differences were observed between the two groups (P = 0.813 and P = 0.101, respectively). With regard to the total cost of perioperative transfusion of all blood products (RBC and plasma), costs for the control group were slightly lower than those of the cell saver group, but this variance did not reach statistical significance (P = 0.095). The use of the cell saver in posterior spinal instrumentation and fusion surgery in school-aged children and adolescents was able to decrease the amount of intraoperative allogeneic RBC transfusion but failed to decrease total perioperative allogeneic RBC transfusion. Moreover, the use of the cell saver was not cost-effective.
Highlights
Primary posterior spinal instrumentation and fusion surgery for scoliosis is a major spinal operation that is associated with massive intraoperative blood loss [1,2]
Some studies have indicated that use of the cell saver decreased red blood cell (RBC) transfusions in scoliosis surgery [5,6,7], while others have demonstrated that cell saver use presented little benefit or might have been associated with increased blood loss [8,9,10,11]
This study examined perioperative blood loss and its management in school-aged children and adolescents undergoing posterior correction of scoliosis with instrumentation and fusion
Summary
Primary posterior spinal instrumentation and fusion surgery for scoliosis is a major spinal operation that is associated with massive intraoperative blood loss [1,2]. Allogeneic RBC transfusion may be related to an increased rate of operative site infections [4]. To decrease the need for allogeneic blood transfusion, alternative approaches such as the use of the cell saver, which can salvage and return the patient’s RBCs, have been widely used intraoperatively [3]. Some studies have indicated that use of the cell saver decreased RBC transfusions in scoliosis surgery [5,6,7], while others have demonstrated that cell saver use presented little benefit or might have been associated with increased blood loss [8,9,10,11]. Few studies have evaluated the intraoperative use of the cell saver in a younger age group such as ours
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