USE OF CELL SAVER IN INSTRUMENTED THORACOLUMBAR SPINAL FUSION SURGERY. SHOULD WE USE IT ROUTINELY?

Abstract

Background: Cell Saver technique using intra-operative autologenous transfusion known to conserve homologous blood resources.

Specific indications for use of cell saver in thoracolumbar spinal instrumented fusion not clearly determined.

No previously published literature from Britain to our knowledge.

Objectives: To identify the clinical factors associated with increased risk of intra-operative blood loss.

• To analyse the safety and benefits of using cell saver technique.

• To determine the cost-effectiveness of use of cell saver technique.

Method: A total of 51 consecutive spinal instrumented fusion cases during last 14 months reviewed.

• There was no randomisation; use of cell saver was at surgeon’s discretion.

• Cell saver group consisted of 25 patients and control group consisted of 26 cases.

• Patients with degenerative scoliosis and tumours excluded.

• Demographic data recorded. Clinical notes reviewed to include smoking status, BMI, pre-operative diagnosis, revision surgery, number of levels fused, use of iliac bone graft, pre and post operative haemoglobin, haematocrit and platelets, intra-operative blood loss, amount of blood salvaged, duration of surgery, nature and amount of allogenic blood transfused.

Results: Demographic data including age, weight, smoking and prior surgery were similar between the two groups.

• Iliac crest bone graft harvested in 20% of cell saver group and 40% in control group.

• Levels of fusion ranged from 1–7 [Mean=2.8] in the cell saver group and 1–4 [Mean=1.9] in the control group.

• Study group averaged 4 hrs of surgery, 15 mins longer than control group.

• Intra-op blood loss higher in cell saver group (mean=1245 mls vs 800 mls).

• Revision surgery did not affect the intra-op blood loss or duration of surgery.

• 20% in cell saver group and 26% in control group required blood transfusion.

• 8 units of red cells was transfused cell saver group as against 17 units of red cells plus 2 units of platelets transfused in the control group.

• Percentage drop in the post operative haematocrit was 19.1 in cell saver group compared to 36.3 in control group.

Conclusion: 44.38% blood salvaged (35–38% in spinal literature).

• Use of cell saver significantly decreased the risk of post-operative need for blood transfusion.

• In this study, number of levels of fusion, duration greater than 4 hrs and a low pre-op Hb/Hct were significant parameters in predicting intra-operative blood loss.

• If blood loss is less than 700 mls, gains from cell saver is debatable.