Efficacy of intraoperative cell salvage in spine surgery: a meta-analysis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Intraoperative cell salvage systems, or cell savers, are widely used for the management of blood loss in patients undergoing spine surgery. However, recent studies report conflicting evidence of their efficacy. The purpose of the meta-analysis was to investigate the efficacy of cell savers in reducing blood transfusion requirements in patients undergoing spine surgery.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Both retrospective and prospective studies that investigated the efficacy of cell savers in reducing transfusion requirements in spine surgery patients when compared with control patients were identified from MEDLINE, Embase, Cochrane Collaboration Library, Google Scholar, and Scopus databases. Outcome data extracted included number of patients receiving allogenic transfusions (transfusion rate); units of allogenic transfusions; postoperative hemoglobin; costs; operative time; and complications. RevMan 5 software was used to perform statistical analyses. A random-effects model was used to calculate pooled odds ratios (with 95% CIs) and weighted mean differences (WMDs [95% CI]) for dichotomous and continuous variables, respectively.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Eighteen studies with 2815 patients in total were included in the meta-analysis. During spine surgery, the use of intraoperative cell salvage did not reduce the intraoperative (OR 0.66 [95% CI 0.30, 1.41]), postoperative (OR −0.57 [95% CI 0.20, 1.59]), or total transfusion (OR 0.92 [95% CI 0.43, 1.98]) rate. There was a reduction in the number of allogenic units transfused intraoperatively by a mean of 0.81 (95% CI −1.15, −0.48). However, there were no differences in the number of units transfused postoperatively (WMD −0.02 [95% CI −0.41, 0.38]) or the total units transfused (WMD 0.08 [95% CI −1.06, 1.22]). There were also no differences in operative time (WMD 19.36 [95% CI −2.43, 42.15]) or complications reported (OR 0.79 [95% CI 0.46, 1.37]) between groups. A difference in postoperative hemoglobin (WMD 0.54 [95% CI 0.11, 0.98]) between both groups was observed.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Cell saver is efficacious at reducing intraoperative allogenic units transfused. There is no difference in transfusion rates, postoperative units transfused, and the total number of units transfused. Further cost analysis studies are necessary to evaluate the cost-effectiveness of this method of blood conservation.</jats:p><jats:p>■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: meta-analysis; strength of recommendation: low.</jats:p></jats:sec>

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

“…169 There is an unclear benefit of preoperative blood donation and its impact on the need for homologous blood 170,171 or on the effect of cell salvage on transfusion rates and total perioperative units of blood transfused. 172 Any benefits of balanced transfusion strategies incorporating plasma-reduced red cell: fresh frozen plasma (1:1) and plasma-reduced red cell: platelets (1:4) are also unclear, 173 as are any benefits of restrictive 174,175 (8 g/dL) versus liberal (10 g/dL) targeted transfusion strategies.…”

Perioperative management of acetabular and pelvic fractures: evidence-based recommendations

“…Cell salvage has been investigated in revision hip arthroplasty, lumbar spine surgery and trauma surgery [74,76,[78][79][80]. A meta-analysis of RCTs demonstrated decreased patient exposure to allogeneic blood transfusions when cell salvage was used in orthopedic surgery [81].…”

Intravenous Tranexamic Acid Reduces Blood Loss in Multilevel Spine Surgeries

“…Given these potential complications, several blood-conservation strategies are used, ranging from intraoperative red blood cell salvage, topical application of fibrin sealants, topical and intravenous antifibrinolytic agents, and anesthesia techniques such as hypotensive anesthesia and normovolemic hemodilution. 1,2,4-7…”

“…Given these potential complications, several blood-conservation strategies are used, ranging from intraoperative red blood cell salvage, topical application of fibrin sealants, topical and intravenous antifibrinolytic agents, and anesthesia techniques such as hypotensive anesthesia and normovolemic hemodilution. 1,2,[4][5][6][7] Tranexamic acid (TXA) is a synthetic lysine analog antifibrinolytic that binds reversibly to lysine-binding sites on plasminogen, allowing plasminogen activation to plasmin but preventing the plasminogen/plasmin molecules from binding to fibrin and degrading it. 8 Intravenous TXA is used in various surgical specialties, such as cardiac surgery, orthopaedic surgery, and obstetrics, where it reduces perioperative blood loss and the need for transfusion by one-third.…”