Top

European Spine Journal

Published in:

01-02-2015 | Original Article

Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study

Authors: Jinqian Liang, Jianxiong Shen, Sooyong Chua, Yu Fan, Jiliang Zhai, Bin Feng, Siyi Cai, Zheng Li, Xuhong Xue

Published in: European Spine Journal | Issue 2/2015

Abstract

Purpose

To determine the safety and efficacy of intraoperative cell salvage system in decreasing the need for allogeneic transfusions in a cohort of scoliosis patients undergoing primary posterior spinal fusion with segmental spinal instrumentation.

Methods

A total of 110 consecutive scoliosis patients undergoing posterior instrumented spinal fusion were randomized into two groups according to whether a cell saver machine for intraoperative blood salvage was used or not. Data included age, body mass index, perioperative hemoglobin levels, surgical time, levels fused, perioperative estimated blood loss, perioperative transfusions and incidence of transfusion-related complications. A Chi-square test and t tests were performed for intraoperative and perioperative allogeneic transfusion between groups. A regression analysis was performed between selected covariates to investigate the predictive factors of perioperative transfusion.

Results

Perioperative allogenic blood transfusion rate was lower in the cell saver group (14.5 versus 32.7 %, p = 0.025). Mean intraoperative red blood cell transfusion requirement was also lower (0.21 U/pt versus 0.58 U/pt, p = 0.032). A multivariate analysis demonstrated that no. of fused segments (OR: 1.472; p = 0.005), preoperative hemoglobin level (OR: 0.901; p = 0.001), and the use of cell saver system (OR: 0.133; p = 0.003) had a trend toward significance in predicting likelihood of transfusion.

Conclusions

Cell saver use significantly reduces the need for allogeneic blood in spine deformity surgery, particularly in patients with low preoperative hemoglobin or longer operation time. This study confirms the utility of routine cell saver use during PSF with segmental spinal instrumentation for scoliosis patients.

Yu X, Xiao H, Wang R, Huang Y (2012) Prediction of massive blood loss in scoliosis surgery from preoperative variables. Spine (Phila Pa 1976) 38:350–355CrossRef

Yagi M, Hasegawa J, Nagoshi N, Iizuka S et al (2012) Does the intraoperative tranexamic acid decrease operative blood loss during posterior spinal fusion for treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 37(21):E1336–E1342CrossRef

Robillard P, Nawej KI, Jochem K (2004) The Quebec hemovigilance system: description and results from the first two years. Transfus Apher Sci 31(2):111–122PubMedCrossRef

Sharma S, Sharma P, Tyler LN (2011) Transfusion of blood and blood products: indications and complications. Am Fam Physician 83(6):719–724PubMed

Shulman G, Solanki DR, Nicodemus CL, Flores IM, Hadjipavlou AG (1998) Audit of autotransfusion in spine surgery. Int Orthop 22(5):303–307PubMedCentralPubMedCrossRef

Nicolai P, Leggetter PP, Glithero PR, Bhimarasetty CR (2004) Autologous transfusion in acetabuloplasty in children. J Bone Joint Surg Br 86(1):110–112PubMed

Meert KL, Kannan S, Mooney JF (2002) Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery. Spine (Phila Pa 1976) 27(19):2137–2142CrossRef

Belisle S, Hardy JF (1996) Hemorrhage and the use of blood products after adult cardiac operations: myths and realities. Ann Thorac Surg 62(6):1908–1917PubMedCrossRef

Munoz GM, Sanchez AY, Garcia VJJ, de la Torre FJM, de la Cruz MD RR, Eloy-Garcia JM (1999) [Pre and post-operative autotransfusion. A comparative study of hematology, biochemistry and red cell metabolism in pre-donated blood and blood from post-operative surgical drainage]. Sangre (Barc) 44(6): 443–450

10.

McMurray MR, Birnbaum MA, Walter NE (1990) Intraoperative autologous transfusion in primary and revision total hip arthroplasty. J Arthroplasty 5(1):61–65PubMedCrossRef

11.

Huet C, Salmi LR, Fergusson D, Koopman-van GAW, Rubens F, Laupacis A (1999) A meta-analysis of the effectiveness of cell salvage to minimize perioperative allogeneic blood transfusion in cardiac and orthopedic surgery. International Study of Perioperative Transfusion (ISPOT) Investigators. Anesth Analg 89(4):861–869PubMedCrossRef

12.

Lisander B, Ivarsson I, Jacobsson SA (1998) Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery. Acta Anaesthesiol Scand 42(6):707–712PubMedCrossRef

13.

Reitman CA, Watters WC 3rd, Sassard WR (2004) The cell saver in adult lumbar fusion surgery: a cost-benefit outcomes study. Spine (Phila Pa 1976) 29(14):1580–1583 (discussion 1584)CrossRef

14.

Siller TA, Dickson JH, Erwin WD (1996) Efficacy and cost considerations of intraoperative autologous transfusion in spinal fusion for idiopathic scoliosis with predeposited blood. Spine (Phila Pa 1976) 21(7):848–852CrossRef

15.

Keverline JP, Sanders JO (1998) Hematuria associated with low-volume cell saver in pediatric orthopaedics. J Pediatr Orthop 18(5):594–597PubMedCrossRef

16.

Weiss JM, Skaggs D, Tanner J, Tolo V (2007) Cell saver: is it beneficial in scoliosis surgery. J Child Orthop 1(4):221–227PubMedCentralPubMedCrossRef

17.

Murphy GJ, Rogers CS, Lansdowne WB, Channon I et al (2005) Safety, efficacy, and cost of intraoperative cell salvage and autotransfusion after off-pump coronary artery bypass surgery: a randomized trial. J Thorac Cardiovasc Surg 130(1):20–28PubMedCrossRef

18.

Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86-A(6):1146–1152PubMed

19.

Ovadia D, Luger E, Bickels J, Menachem A, Dekel S (1997) Efficacy of closed wound drainage after total joint arthroplasty. A prospective randomized study. J Arthroplasty 12(3):317–321PubMedCrossRef

20.

Lennon RL, Hosking MP, Gray JR, Klassen RA, Popovsky MA, Warner MA (1987) The effects of intraoperative blood salvage and induced hypotension on transfusion requirements during spinal surgical procedures. Mayo Clin Proc 62(12):1090–1094PubMedCrossRef

21.

Vitale MG, Privitera DM, Matsumoto H, Gomez JA et al (2007) Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients. Spine (Phila Pa 1976) 32(24):2662–2667CrossRef

22.

Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC Jr, Dekutoski MB, Bryant S (2000) Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine (Phila Pa 1976) 25(5):596–601CrossRef

23.

Dekutoski MB (1999) Blood loss and transfusion management in spinal surgery. Orthopedics 22(1 Suppl):s155–s157PubMed

24.

Winter SL, Kriel RL, Novacheck TF, Luxenberg MG, Leutgeb VJ, Erickson PA (1996) Perioperative blood loss: the effect of valproate. Pediatr Neurol 15(1):19–22PubMedCrossRef

25.

Vitale MG, Levy DE, Park MC, Choi H, Choe JC, Roye DP Jr (2002) Quantifying risk of transfusion in children undergoing spine surgery. Spine J 2(3):166–172PubMedCrossRef

26.

Lee JH, Lee SH, Oh JH (2003) Minimal effective dosage of recombinant human erythropoietin in spinal surgery. Clin Orthop Relat Res 412:71–76PubMedCrossRef

27.

Shapiro GS, Boachie-Adjei O, Dhawlikar SH, Maier LS (2002) The use of Epoetin alfa in complex spine deformity surgery. Spine (Phila Pa 1976) 27(18):2067–2071CrossRef

Title: Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study
Authors: Jinqian Liang
Jianxiong Shen
Sooyong Chua
Yu Fan
Jiliang Zhai
Bin Feng
Siyi Cai
Zheng Li
Xuhong Xue
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 2/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3282-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2015

Correlation between Cobb angle, spinous process angle (SPA) and apical vertebrae rotation (AVR) on posteroanterior radiographs in adolescent idiopathic scoliosis (AIS)

Do recovery expectations change over time?

Influence of anatomical variations on lumbar foraminal stenosis pathogenesis

Factors relating to curve progression in female patients with adolescent idiopathic scoliosis treated with a brace

Diffusion-weighted magnetic resonance imaging for the diagnosis of patients with lumbar nerve root entrapment syndromes: results from a pilot study

Comparative observational study of surgical outcomes of lumbar foraminal stenosis using minimally invasive microsurgical extraforaminal decompression alone versus posterior lumbar interbody fusion: a prospective cohort study