Intraoperative Salvage Research Articles

In brief

Study Objective: To analyze intraoperative autologous salvage of shed mediastinal blood and subsequent transfusion in cardiac surgery.Design: Retrospective statistical analysis.Setting: University hospital.Patients: Three thousand twenty two patients undergoing cardiac surgery from 1984 to 1988.Interventions: A review of anesthesia and transfusion records of all patients who underwent intraoperative salvage of shed blood and autologous transfusion using the Sorenson Receptal Auto Transfusion System (ATS) with saline wash prior to reinfusion in cardiac surgery.Measurements and Main Results: The salvaged blood volume ranged from 36 to 2,795 ml, with a mean of 321 ± 222 ml (SD). Eighteen percent of patients did not receive any homologous blood products during their hospitalization. Patients who received only salvaged autologous transfusion were younger, had higher preoperative hemoglobin and hematocrit values, had a larger body surface area, and had shorter surgeries compared with patients who received only homologous blood or both autologous and homologous blood. More blood products were given to patients who received salvaged autologous blood compared with those who did not. Patients who underwent normovolemic hemodilution prior to extracorporeal circulation with subsequent reinfusion received significantly fewer blood products. Ten preoperative and, four intraoperative variables significantly influenced the salvaged volume. Previous cardiac surgery was the most significant preoperative variable, and repair of ventricular septal defect produced by myocardial ischemia was the most significant intraoperative variable.Conclusion: Considering the average salvaged volume and its current autologous transfusion-related expense, autologous blood salvage is potentially an economic benefit. Perioperative blood conservation requires a considerable commitment from surgeons, anesthesiologists, perfusionists, and intensive care physicians to be effective.

Blood Loss and Intraoperative Salvage Procedure in Patients Underwent Coronary Artery Bypass Reoperative Surgery

Preoperative patients` characteristics can predict the need for perioperative blood component transfusion in cardiac operations. Currently, a large number of patients are on antiplatelet therapy. A group of these patients require reoperative surgery (redo) after coronary artery bypass grafting (CABG). We aimed to compare blood loss in patients having CABG with patients undergoing reoperative CABG surgery. Fifty-four patients (16% female, 84% male; ages 60.5 ± 6 vs. 66.2 ± 7 years) were divided in: Group 1–CABG, and Group 2–redo CABG. Blood samples were collected: 24h prior, 6h and 24h after the operation. We measured hematological parameters and total amount of blood products substituted. Preoperative clopidogrel and aspirin therapy were not statistically significant (p=0.094), while platelet count (p=0.002) was significantly lower in Group 2. Although we have found some differences in the blood drained (868.5 ± 587 vs. 1088 ± 819 mL) it was not statistically relevant (p=0. 28). Allogenic erythrocytes substituted intraoperatively were not statistically different (p=0.61), while autologous blood salvage procedure was weakly significant (p=0.05). Platelets transfused (p=0.88), fresh frozen plasma (p=0.68), and packed red blood cells transfused postoperatively (p=0.32) have not reached statistical significance. Length of stay in intensive care unit (ICU) was not influenced by used blood components transfusion, either allogenic or autologous. We have found positive correlation between blood loss and ICU stay (r=0.49, p=0.021). Monitoring of these parameters offers an important addition to the preoperative risk assessment.

Cell Salvaging Reduces the Severity of Dilutional Coagulopathy (as Evaluated Through the Consumption of Blood Products) in Liver Transplantation.

Abstract 2290 Background:Intra-operative autologous red blood cell (RBC) salvaging (SRBC) reduces requirements for allogeneic RBC transfusion during surgery, and should be considered in surgeries with anticipated blood losses over 1 L. However, the auto-transfusion of large volumes of SRBC can lead to dilutional coagulopathy, due to the loss of clotting factors and platelets during cell processing, worsening the outcome of surgery.Orthotopic liver transplantation (OLT) has historically been associated with major blood loss and massive blood transfusion due to the aggressiveness of surgery, the anhepatic phase and the pre-existing underlying disease. While transfusion requirements have been greatly reduced over the past decade, large volumes correlate with worsened prognosis and can also lead to dilutional coagulopathy.Most published series on cell salvaging focus on orthopedic, cardiac or oncologic patients, and data on its use in liver transplantation remains insufficient and contradictory, with the suggestion that salvage is associated with a higher degree of dilutional coagulopathy than allogeneic transfusion. Methods:We performed a retrospective analysis of a 5-year series of OLT patients undergoing surgery (including for fulminant liver failure) in our Centre, comparing the number of units of Red Cell Concentrate (RCC) transfused during each procedure and the volume of autologous SRBC obtained intra-operatively and reinfused before the conclusion of surgery, with the number of units of fresh frozen plasma (Plasma) and Platelet Concentrate (PC) consumed, as a clinical marker of the depth of coagulopathy, both through univariate and multivariate analysis. Results:A total of 218 OLTs were analyzed; an average of 13.6±17.5 units (U) of RCC, 7.4±12.4 U of Plasma and 5.0±7.9 U of PC were used. In one third of patients (30.7%) no allogeneic RCC was transfused, and in a further third (34.4%) less than 5 U were consumed, resulting in a median of 2 U of RCC per patient. A mean of 1003.4±1061.3 mL of SRBC were reinfused in the 70 patients (32.1%) who underwent salvage.There was no correlation between the number of RCC units and the volume of SRCB infused (−0.04, p=NS), and the mean volume of SRBC was not different between patients who were transfused with RCC (315.3±845.4) and those who were not (337.7±527.0, p=NS); on the other hand, patients who underwent cell salvage used significantly less units of RCC (3.3±6.1) than those who did not (9.4±14.1, p<0.001).We found a strong correlation between the number of Plasma and PC units administered (0.73, p<0.001), and between the number of RCC and Plasma (0.91, p<0.001) and PC units (0.68, p<0.001) used; patients who were transfused with at least 1 U of RCC consumed significantly more Plasma (18.7±18.7 U) and PC (7.1±8.6 U) than patients who did not receive any allo-RCC (1.9±4.0, p<0.001 and 0.3±1.8, p<0.001, respectively). Likewise, there was a significant correlation between the volume of SRBC and the number of Plasma (0.63, p<0.001) and PC units used (0.31, p=0.009); however, patients who underwent cell salvage used significantly less Plasma (7.4±11.7 U) and PC (2.8±6.1 U) than patients who did not (16.1±19.1, p<0,001 and 6.1±8.4, p=0.002, respectively), and patients who received only autologous SRBC were transfused with significantly less Plasma (2.0±4.4 U) and PC (0.0±0.0 U) than patients who received only allogeneic RCC units (20.6±19.8, p<0.001 and 7.6±8.9, p<0.001, respectively). Discussion:The choice to use SRBC was introduced a priori, as reflected in the absence of correlation between the volume of RCC and SRBC used. However, the use of salvaging resulted in a significantly lower need for allogeneic RCC.The volume of allo or auto-RBC needed during surgery correlated with the severity of coagulopathy, and the number of Plasma and PC units administered to revert it were strongly correlated, as expected. However, the choice to use SRBC was associated with a decrease in the volume of Plasma and PC needed, when compared to surgeries without salvaging. Likewise, the exclusive use of SRBC resulted in a significantly lower use of Plasma and PC during surgery than the exclusive use of allo-RCC. Conclusion:In our series, intraoperative salvaging not only reduced the consumption of RCC, but was also associated with a lower severity of surgical coagulopathy, as evaluated clinically through the number of units of Plasma and PC needed to stabilize the patient. Disclosures:No relevant conflicts of interest to declare.

Strategies for Recognizing and Managing Intraoperative Venous Congestion in Abdominally Based Autologous Breast Reconstruction

Despite common superficial venous system dominance of the abdominal wall, the majority of transverse rectus abdominis musculocutaneous (TRAM)/deep inferior epigastric perforator (DIEP) flaps drain adequately, due to communicating veins with the deep system. In cases where such connections are inadequate, it is necessary for the surgeon to correctly recognize resultant congestion as an intrinsic flap issue, and treat it intraoperatively. A retrospective analysis of 1201 consecutive TRAM/DIEP free flaps over a 5-year period was performed. All cases of inadequate venous outflow not due to technical anastomotic problems or venous thrombosis were identified and analyzed. From a cohort of 1201 patients undergoing free TRAM and DIEP flap breast reconstruction, 11 (0.9 percent) exhibited intraoperative congestion due to persistent superficial venous system dominance, despite patent deep vein anastomosis. Most commonly (five flaps), anastomosis of the superficial inferior epigastric vein (SIEV) to a proximally dissected vena comitans of the flap deep inferior epigastric vein system (DIEV) was performed; thus, a superficial to deep venous loop was created within the flap. Intraoperative salvage rate was 100 percent. In this series, intraoperative congestion is most commonly due to a superficially dominant flap. In such flaps, the deep venous anastomosis is patent, and yet adequate venous drainage cannot be achieved due to the lack of communicating vessels between the two systems, or due to inadequate perforator selection. Anastomosis of the SIEV to a proximally dissected vena comitans of the DIEV on the flap was performed most commonly in our series. This allows anastomosis of two veins in close proximity, and avoidance of using a second recipient vein. Therapeutic, IV.

Management of Extensive Intracardiac Thombosis in a Patient with Polycythemia Vera Undergoing Coronary Artery Bypass Grafting

Polycythemia vera (PV) is a chronic myeloproliferative disorder with a predilection for thrombotic complications in affected patients. Intracardiac thrombosis is a rare manifestation of this disease, as documented in only a few published cases. In this report, we describe a PV patient who suddenly developed extensive thrombosis within all four cardiac chambers and severe ventricular dysfunction during a coronary artery bypass procedure. We also detail the intraoperative salvage maneuvers implemented in this case, which included deep hypothermic circulatory arrest with retrocerebral perfusion and four chamber thrombectomy.

Effect of leukocyte-depleted intraoperative salvaged Mood on erythrocyte immunity and systemic inflammatory response during perioperative period

Objective To investigate the effect of leukocyte-depleted intraoperative salvaged blood on the erythrocyte immunity and systemic inflammatory response during the perioperative period in patients. Methods Twenty ASA Ⅰ or Ⅱ patients, aged 20-44 yr, weighing 40-75 kg, required blood salvage during operations (intraoperative blood loss expected 15-20 ml/kg), were randomly divided into 2 groups ( n = 10 each): control group (group C) and leukocyte depletion group (group D) . Anesthesia was induced with midazolam, fentanyl, propofol and vecuronium and maintained with isoflurane inhalation and iv infusion of propofol and remifentanil. The patients were mechanically ventilated after tracheal intubation. Intraoperative blood salvage and reinfusion were performed in all patients using cell saver system. In group D, the salvaged blood was filtered with a leukocyte depleting filter placed in the line of the reinfusion circuit. Blood samples were collected from the central vein before anesthesia (T1 ) , at the end of surgery (T2 ) , and at 12 h (T3 ) and 36 h (T4 ) after operation in the two groups. The rosette rates of RBC-C3b receptors and RBC-immune complex were determined. The leukocyte and neutrophil were counted. The plasma levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and malondialdehyde (MDA) were measured. Results The plasma levels of IL-6, TNF-a and MDA were significantly lower at T2-4 , the rosette rate of RBC-C3b receptors was significantly higher at T3-4 ( P ＜ 0.01) , and the neutrophil count was significantly lower at T4 in group D than in group C ( P ＜ 0.05) . Conclusion Leukocyte-depleted intraoperative salvaged blood is helpful to improve the erythrocyte immunity during the perioperative period in patients, and the decrease in the systemic inflammatory response may be involved in the mechanism. Key words: Leukapheresis; Blood transfusion,autologous; Immunity, cellular; Erythrocytes; Inflammation

Surgical Strategies to Salvage the Venous Compromised Deep Inferior Epigastric Perforator Flap

Elevation of the deep inferior epigastric perforator (DIEP) flap interrupts its superficial venous system, and if drainage through the deep venous system is inadequate the flap may develop congestion. The purpose of this retrospective study was to determine the fate of the congested DIEP flap and to optimize the strategy for its salvage. Thirty-two of 162 patients who underwent unilateral breast reconstruction with a DIEP flap developed venous congestion. For the purpose of outcome analysis, cases were retrospectively allocated to "observation-only" (group A, n = 11), postoperative salvage (group B, n = 7), and intraoperative salvage (group C, n = 14), and complications among the various groups were compared to determine the necessity and optimal timing of salvage intervention. Two flaps (1 in group A, another in group B) failed completely, giving a success rate 98.8%. The complication rate and hospital stay were significantly lower in group C than in group B (P = 0.03, P = 0.02). The rate of venous congestion requiring salvage procedures was 13%, with a salvage rate of 95%. Salvage procedures included venous augmentation with an additional recipient vein in 7 procedures, adding superficial inferior epigastric vein (SIEV) to DIEV in 11 procedures, and substituting with SIEV in 7 procedures. There was no statistical difference in flap salvage rate using the SIEV between "augmentation" and "substitution." The salvage procedures for venous compromised DIEP flap are better performed intraoperatively rather than postoperatively to prevent further complications. The engorged SIEV could be incorporated by anastomosing to an additional recipient vein or adding to the DIEV-internal mammary vein axis or substituting for DIEV.

Alternative Procedures for Reducing Allogeneic Blood Transfusion in Elective Orthopedic Surgery

Perioperative blood loss is a major problem in elective orthopedic surgery. Allogeneic transfusion is the standard treatment for perioperative blood loss resulting in low postoperative hemoglobin, but it has a number of well-recognized risks, complications, and costs. Alternatives to allogeneic blood transfusion include preoperative autologous donation and intraoperative salvage with postoperative autotransfusion. Orthopedic surgeons are often unaware of the different pre- and intraoperative possibilities of reducing blood loss and leave the management of coagulation and use of blood products completely to the anesthesiologists. The goal of this review is to compare alternatives to allogeneic blood transfusion from an orthopedic and anesthesia point of view focusing on estimated costs and acceptance by both parties.

Intraoperative salvage of a renal artery occlusion during fenestrated stent grafting

A 79-year-old man with a 6-cm juxtarenal abdominal aortic aneurysm was treated by endovascular means with a fenestrated stent graft. The completion angiogram revealed a left renal artery occlusion. A retroperitoneal surgical approach allowed for retrograde catheterization of the occluded covered stent through the left renal artery. The covered stent was reopened by balloon angioplasty. After 2 months, the left renal artery was patent and renal function normal. At 6 months, both renal arteries were fully open on duplex imaging. The open retroperitoneal approach with retrograde catheterization is a bailout technique to avoid loss of a kidney in fenestrated stent grafting.

Ventricular fibrillation by hypothermia in spinal fusion surgery: A case report.

A 63-year-old man was scheduled for T12-S1 posterolateral spinal fusion surgery. The patient's vital signs were stable and there were no specific laboratory findings except for high triglycerides. In addition, echocardiography showed mild left ventricular hypertrophy, but normal left ventricular function, no regional wall abnormal contractility and normal ejection fraction. During the operation, a warming blanket and fluid warmer were applied. Near the end of the operation, the blood pressure waveform from the radial artery and pulse oxymeter became flat. Cardiotonics were administered and an infusion of intraoperative salvage of blood was administered using the cell-saver. However, the hemodynamic status of the patient deteriorated to severe hypotension, with ventricular fibrillation. The patient's vital signs with temperature became stabilized after warming for 4 hours using active warming methods, including a forced air warming blanket and warming of the fluids and blood components with a rapid infusion system.

Influence of intraoperative blood cell salvage on erythrocyte immunity and immunoreceptor expression

Objective To investigate the influence of intraoperative blood cell salvage on erythrocyte immunity and the expression of CD35 and CD58. Methods Sixteen patients undergoing total hip replacement or artificial femoral head arthroplasty were chosen. Blood (5 ml) was collected from operation field and from cell saver, respectively to measure rosette rate of RBC · C3b receptor (RCR) and immune complex rosette rate of red cell (RICR). The expression of CD35 and CD58 on erythrocytes was detected with flow cytometer. Results Both RCR and RICR from cell saver, and the expression of CD35 and CD58 on erythrocytes from cell saver were significantly lower than those from operation field. Conclusion Intraoperative salvage of blood cells inhibits the erythrocyte immunity, which may be related to the inhibition of CD35 and CD58 expression on erythrocytes. Key words: blood salvage; erythrocyte immunity; CD35 ; CD58

Recombinant activated factor VII and intraoperative use of cell saver in neurosurgical treatment of arteriovenal malformation

Arteriovenous (AV) malformation of brain causes abundant intraoperative bleedings, because of increased blood flow, which complicates operative treatment. The use of cell saver for intraoperative salvage of blood and recombinant activated factor VII (rFVIIa) significantly reduces complications during operative treatment. We present a 29-year old male patient with AV malformation of the 4th degree on Spetzler-Martin scale. Because of the possibility of abundant bleeding, a cell saver (Sequestra 1000 Metronic, USA) was used, and to achieve and control adequate haemostasis, we used rFVIIa. The use of cell saver for intraoperative blood salvage and rFVIIa proved successful in operative treatment of AV malformation of 4th degree.

Results of the 1.5-ventricle repair for Ebstein anomaly and the failing right ventricle

Repair of Ebstein anomaly and impaired right ventricular function pose challenges for the cardiac surgeon. The bidirectional cavopulmonary shunt may improve early outcomes. We reviewed our experience with the 1.5-ventricle repair in this patient population. Between July 1999 and March 2006, 169 patients underwent operations to repair Ebstein anomaly. Fourteen patients had a bidirectional cavopulmonary shunt constructed. The median age at operation was 6 years (17 months-57.8 years). All of the patients had severe Ebstein anomaly with dilated right-sided chambers and/or right ventricular dysfunction. The mean left ventricular ejection fraction was 54.5% (range 35%-72%). Three patients were initially referred for heart transplantation, and the bidirectional cavopulmonary shunt allowed a conventional repair. Procedures included bidirectional cavopulmonary shunting (14), tricuspid valve replacement (11), tricuspid valve repair (2), and right ventricular resection (3). Shunting was planned preoperatively in 9 patients; the indication in 5 other patients was hemodynamic instability after separation from cardiopulmonary bypass. One patient died of multiple organ failure. Median follow-up in 10 patients was 18 months (3 months-6.5 years). The preoperative left ventricular ejection fraction of less than 50% improved in 3 patients to greater than 50% postoperatively. The 1.5-ventricle repair can be utilized in patients with severe Ebstein anomaly and impaired right ventricular function who are at high risk for surgical treatment. We believe the bidirectional cavopulmonary shunt may be considered as a planned procedure, as an intraoperative salvage maneuver, or as an alternative to cardiac transplantation in selected patients.

Autologous predonation, haemodilution and intraoperative blood salvage in elective abdominal aortic aneurysm repair.

The feasibility of predonated autologous blood transfusion and intraoperative blood salvage in elective abdominal aortic aneurysm repair was studied. Twenty consecutive patients were evaluated, of whom five were excluded according to protocol criteria. Patients each donated 1 unit blood 14 and 7 days before operation. A third unit was withdrawn in the anaesthetic room and replaced with Hartmann's solution, producing a haemodiluted state. Intraoperative losses were minimized using the Haemonetics Cell Saver III Plus autotransfusion system. Predonated blood from two patients passed its expiry date owing to repeated operation postponements, leaving 13 patients for study. The mean(s.d.) intraoperative blood loss was 700(300) ml with a mean(s.d.) intraoperative salvage of 420(300) ml. Two patients were transfused intraoperative salvage of 420(300) ml. Two patients were transfused according to clinical need. Thus nine patients safely avoided homologous transfusion. With autologous predonation, haemodilution and intraoperative blood salvage, elective aortic aneurysm repair can be performed safely with minimal need for homologous blood.

Clinical application of intraoperative autotransfusion devices during anterior decompression and instrumentation for thoracolumbar burst fracture

目的 探讨术中自体血回输在胸腰椎爆裂骨折前路手术中的应用. 方法 87例胸腰椎爆裂骨折行前路减压植骨内固定术,采用术中自体血回输技术,观察自体血回输安全性.术中平均出血 1180mL,收集红细胞液的压积为 50%的自体血回输. 结果术中平均回吸收红细胞压积 50%自体血 450mL,无输血反应及过敏反应发生,明显减少异体库血需要量. 结论术中自体血回输在胸腰椎爆裂骨折前路手术中的应用是安全可靠的,有临床应用价值.

Gerard W. Ostheimer “What’s New in Obstetric Anesthesia” Lecture

Gerard W. Ostheimer “What’s New in Obstetric Anesthesia” Lecture

Molecular evidence of tumour cell removal from salvaged blood after irradiation and leucocyte depletion.

Intra-operative autologous blood recovery offers many advantages. However, blood salvage during cancer surgery is of limited use due to the potential presence of circulating tumour cells. It was the aim of this study to show that intra-operative salvage blood can be freed of cells and cellular DNA after leucoreduction by filtration and irradiation of washed blood. Known amounts of tissue culture derived from carcinoma, melanoma and osteosarcoma were added to whole blood bags. This mixture was then submitted to washing, leucoreduction and irradiation. Samples were studied stepwise in relation to the integrity and size of DNA by the polymerase chain reaction (PCR). After filtration and irradiation, PCR targeting the beta-globin gene (268 bp amplicon) was negative. Our results were corroborated by studying plasma samples added with tumoural cells. Using PCR methodology, we showed the absence of DNA from cells in experimentally contaminated blood and plasma bags after filtration and irradiation. This experimental study is an effort to ensure the safety of intra-operative autologous transfusion.

Economic analysis of an intraoperative cell salvage service.

In the United States, the cost of erythrocyte transfusion exceeds 1.3 billion dollars annually. The fear of viral disease transmission popularized intraoperative salvage to reduce the use of banked blood. Although the economics of this technique have been questioned, the financial variables in providing an intraoperative autotransfusion service have not been analyzed. We designed mathematical models to determine the most cost-effective strategy based on hospital caseload. Four models were analyzed with a spreadsheet to project costs of an intraoperative autotransfusion service when fully or partially outsourced, performed by a full-time technician employee, or performed by a cross-trained employee. The Partially Outsourced model was more economical than the Fully Outsourced model when the annual caseload exceeded 185 cases. The New Employee model became more economical than the Fully Outsourced model when the annual caseload exceeded 110 cases. The Cross-Trained model was the most economical when annual caseload exceeded 55 cases. Cross-training an employee as a cell salvage technician is more economical than outsourcing when caseload exceeds 55 per year.

Survey of anesthesia practice in spine surgery patients in the United States.

There is a wide range of anesthetic practice in spine surgery with respect to anesthetic choice, blood conservation, and monitoring. There is no ideal technique with respect to each of these choices. This study was designed to determine the usual practice for members of the Society of Neurosurgical Anesthesia and Critical Care (SNACC), with regard to the use of anesthetic technique, the type of monitoring used (and the person responsible for its application and interpretation), and the blood conservation strategies most often utilized for the management of patients undergoing spinal surgery. A total of 415 questionnaires were mailed to all current members of the SNACC. Of these, 85 (23%) were completed and returned. The majority of the respondents administer general anesthesia for lumbar laminectomy. Somatosensory evoked potential (SSEP) monitoring is available at most of the institutions (94%) but only utilized in 75% of patients undergoing a Harrington rod placement. Motor evoked potential monitoring is available at 50% of the institutions, but utilized 25% of the time for these surgeries. The two most frequent blood conservation strategies utilized are intraoperative salvage and autologous donation. The most frequent monitoring utilized for major spinal surgeries is SSEP. Autologous donation and intraoperative salvage are the most frequent blood conservation methods utilized.

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

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.