Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system: a retrospective comparison

Abstract

This study investigates efficacy and safety of routine cell salvage system use in adolescent idiopathic scoliosis patients undergoing primary posterior spinal fusion surgery with segmental spinal instrumentation. Forty-five consecutive adolescent idiopathic scoliosis patients undergoing posterior spinal fusion by two surgeons at a single hospital were studied. Intraoperative cell salvage system was used in 23 patients, and the control group was 22 patients who underwent surgery without cell salvage system. The cell salvage system was the Haemonetics Cell Saver 5. The primary outcome measures were intraoperative and perioperative allogeneic transfusion rate, difference between preoperative and discharge Hg and Hct levels. Average patient age was 14.65 ± 1.49 in cell saver group and 13.86 ± 2.0 in control group. In cell saver group, average intraoperative autotransfusion was 382.1 ± 175 ml. Average perioperative allogeneic blood transfusion need was 1.04 ± 0.7 unit in cell saver group and 2.5 ± 1.14 unit in control group. No transfusion reactions occurred in either group. Average hemoglobin level in cell saver group was 10.7 ± 0.86 and average hemoglobin level in control group was 10.7 ± 0.82 on discharge. Cell saver reduces perioperative transfusion rate in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis.

Optimal surgical care for adolescent idiopathic scoliosis: an international consensus

“…The value of each component cannot be determined from this study. There is evidence from uncontrolled studies that cell saver reduces perioperative transfusion rate in patients undergoing posterior spinal fusion for AIS patients [54,55].…”

The pattern of blood loss in adolescent idiopathic scoliosis

“…A placebo-controlled study in pediatric patients undergoing scoliosis surgery found that TXA reduced blood loss by 41% [15]. Cell salvage has been shown to reduce allogeneic transfusion rates in spinal surgery [3,18,19], but recent review articles show little evidence to support its routine use [12,14]. A nonrandomized study has even showed increased blood loss in the cell-saver group [20].…”

Influence of Intraoperative Blood Salvage on Surgery for Scoliosis

“…In another study, 3 a perioperative blood approach similar to that of the authors cited above was adopted, 8 when evaluating 45 patients submitted to posterior arthrodesis of the spine with segmental instrumentation for adolescent idiopathic scoliosis with or without intraoperative blood salvage. As they demonstrated, there was less need for perioperative allogeneic blood transfusion in the group of patients who used IBS (23 patients) than in the control group (22 patients).…”

“…Arthrodeses of the spine are commonly associated with high volumes of bleeding (650 to 2.839 ml). [1][2][3] This is a common problem, particularly in arthrodeses involving more than one level. Greater blood loss may require transfusions of blood derivatives.…”

“…After the filtering process, the patient's erythrocytes are reinfused back into the patient. 3 This method can, occasionally, eliminate the need to collect blood from the patient prior to surgery for an autologous infusion during surgery, as well as the need for allogeneic transfusion. Other advantages are: the absence of transmission of viral diseases, reduced risk of alloimmunization, normal concentration of potassium, considering the fact that the cells are infused at room temperature.…”