Jeffrey L Gum1, Leah Yacat Carreon2, Michael P Kelly3, Richard Hostin4, Chessie Robinson5, Douglas C Burton6, David W Polly7, Christopher I Shaffrey8, Virginie LaFage9, Frank J Schwab9, Christopher P Ames10, Han Jo Kim11, Justin S Smith8, R Shay Bess12. 1. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA. 2. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA. Electronic address: leah.carreon@nortonhealthcare.org. 3. Department of Orthopedic Surgery, Institutes of Health, 5th Fl., Washington University School of Medicine, 660 S. Euclid Ave., Saint Louis, MO 63110, USA. 4. Baylor Scoliosis Center, 4708 Alliance Blvd, Suite 800, Plano, TX 75093, USA. 5. Center for Clinical Effectiveness, Baylor Scott & White Health, 8080 N. Central Expressway, Ste. 500, Dallas, TX 75206, USA. 6. Marc A Asher MD Comprehensive Spine Center, 3901 Rainbow Blvd, MS 3017, Kansas City, KS 66160, USA. 7. Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th St, Suite R200, Minneapolis, MN 55454, USA. 8. Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908, USA. 9. Department of Orthopaedic Surgery, New York Spine Institute, 761 Merrick Ave, Westbury, NY 11590, USA. 10. Department of Neurosurgery, University of California-San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA. 11. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA. 12. Presbyterian/St. Luke's Medical Center & Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA.
Abstract
STUDY DESIGN: Retrospective cohort. OBJECTIVES: To determine if the use of cell saver reduces overall blood costs in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Recent studies have questioned the clinical value of cell saver during spine procedures. METHODS: ASD patients enrolled in a prospective, multicenter surgical database who had complete preoperative and surgical data were identified. Patients were stratified into (1) cell saver available during surgery, but no intraoperative autologous infusion (No Infusion group), or (2) cell saver available and received autologous infusion (Infusion group). RESULTS: There were 427 patients in the Infusion group and 153 in the No infusion group. Patients in both groups had similar demographics. Mean autologous infusion volume was 698 mL. The Infusion group had a higher percentage of EBL relative to the estimated blood volume (42.2%) than the No Infusion group (19.6%, p < .000). Allogeneic transfusion was more common in the Infusion group (255/427, 60%) than the No Infusion group (67/153, 44%, p = .001). The number of allogeneic blood units transfused was also higher in the Infusion group (2.4) than the No Infusion group (1.7, p = .009). Total blood costs ranged from $396 to $2,146 in the No Infusion group and from $1,262 to $5,088 in the Infusion group. If the cost of cell saver blood was transformed into costs of allogeneic blood, total blood costs for the Infusion group would range from $840 to $5,418. Thus, cell saver use yielded a mean cost savings ranging from $330 to $422 (allogeneic blood averted). Linear regression showed that after an EBL of 614 mL, cell saver becomes cost-efficient. CONCLUSION: Compared to transfusing allogeneic blood, cell saver autologous infusion did not reduce the proportion or the volume of allogeneic transfusion for patients undergoing surgery for adult spinal deformity. The use of cell saver becomes cost-efficient above an EBL of 614 mL, producing a cost savings of $330 to $422. LEVEL OF EVIDENCE: Level III.
STUDY DESIGN: Retrospective cohort. OBJECTIVES: To determine if the use of cell saver reduces overall blood costs in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Recent studies have questioned the clinical value of cell saver during spine procedures. METHODS:ASDpatients enrolled in a prospective, multicenter surgical database who had complete preoperative and surgical data were identified. Patients were stratified into (1) cell saver available during surgery, but no intraoperative autologous infusion (No Infusion group), or (2) cell saver available and received autologous infusion (Infusion group). RESULTS: There were 427 patients in the Infusion group and 153 in the No infusion group. Patients in both groups had similar demographics. Mean autologous infusion volume was 698 mL. The Infusion group had a higher percentage of EBL relative to the estimated blood volume (42.2%) than the No Infusion group (19.6%, p < .000). Allogeneic transfusion was more common in the Infusion group (255/427, 60%) than the No Infusion group (67/153, 44%, p = .001). The number of allogeneic blood units transfused was also higher in the Infusion group (2.4) than the No Infusion group (1.7, p = .009). Total blood costs ranged from $396 to $2,146 in the No Infusion group and from $1,262 to $5,088 in the Infusion group. If the cost of cell saver blood was transformed into costs of allogeneic blood, total blood costs for the Infusion group would range from $840 to $5,418. Thus, cell saver use yielded a mean cost savings ranging from $330 to $422 (allogeneic blood averted). Linear regression showed that after an EBL of 614 mL, cell saver becomes cost-efficient. CONCLUSION: Compared to transfusing allogeneic blood, cell saver autologous infusion did not reduce the proportion or the volume of allogeneic transfusion for patients undergoing surgery for adult spinal deformity. The use of cell saver becomes cost-efficient above an EBL of 614 mL, producing a cost savings of $330 to $422. LEVEL OF EVIDENCE: Level III.
Authors: James P Caruso; Mark N Pernik; Zachary D Johnson; Tarek Y El Ahmadieh; Babatunde Ogunnaike; Owoicho Adogwa; Salah G Aoun; Carlos A Bagley Journal: Surg Neurol Int Date: 2021-10-11
Authors: Marcelo A Pinto; Marcio F Chedid; Leo Sekine; Andre P Schmidt; Rodrigo P Capra; Carolina Prediger; João E Prediger; Tomaz Jm Grezzana-Filho; Cleber Rp Kruel Journal: World J Gastrointest Surg Date: 2019-01-27