Randomized trial of Cell Saver in 2- to 3-level lumbar instrumented posterior fusions

Djurasovic, Mladen; McGraw, Katlyn E.; Bratcher, Kelly R.; Crawford, Charles H.; Dimar, John R.; Puno, Rolando M.; Glassman, Steven D.; Owens, R. Kirk; Carreon, Leah Y.

doi:10.3171/2018.4.spine18116

Cited by 9 publications

(18 citation statements)

References 22 publications

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“…In addition, we routinely use cell saver for autotransfusion to avoid allogeneic blood transfusions. 14 Because of the decrease in blood loss, no suprafascial or subfascial drain was used in the MIS cohort. A prospective randomized clinical study by Hung et al 15 demonstrated no significant differences in perioperative outcomes (eg, operative time, EBL, LOS, and complications) in MIS TLIF cases with and without closed suction wound drainage.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Comparison Between Open Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion With Bilateral Facetectomies

Anderson

Phan

et al. 2020

Global Spine Journal

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Study Design: Age- and sex-matched cohort study. Objectives: To compare outcomes after open versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with bilateral facetectomies. Methods: We retrospectively compared patients who underwent single- or 2-level MIS-TLIF with an age- and sex-matched open-TLIF cohort. Surgical data was collected for operative time, estimated blood loss (EBL), and drain use. Clinical outcomes included the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), length of stay (LOS), complications, and reoperations. Lumbar radiographs were measured for changes in global lumbar lordosis (LL) and segmental lordosis (SL). Results: Between 2016 and 2020, 38 MIS-TLIF patients were compared with 38 open-TLIF patients. No subfascial drain was used in the MIS-TLIF group ( P < .001). The MIS-TLIF group had longer operative time (310.8 vs 276.5 minutes; P = .046) but less EBL (282.4 vs 420.8 mL; P = .007). LOS ( P = .15), complication rates ( P = .50), and revision rates ( P = .17) were equivalent. VAS and ODI improved but did not differ between groups. In the open-TLIF group, LL and SL were restored or improved in 81.6% and 86.9% of cases, respectively. In the MIS-TLIF group, LL and SL were restored or improved in 86.8% and 97.4% of cases, respectively. There were no differences in changes in LL and SL between groups. Conclusions: Compared with the age- and sex-matched open-TLIF cohort, patients undergoing MIS-TLIF had reduced EBL and subfascial drain use but increased operative time. There were no differences in complications, reoperations, or LOS. Both groups demonstrated improvement in VAS and ODI. MIS-TLIF with bilateral facetectomies provided equivalent improvements in global and segmental LL.

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Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Comparison Between Open Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion With Bilateral Facetectomies

Anderson

Phan

et al. 2020

Global Spine Journal

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“…Points are awarded in each section, with a maximum of 9 points awarded for lowest-bias observational studies. Bias of study was categorized as high (0-3), medium (4-6), or low (6)(7)(8). Prospective studies were assessed as outlined by Jadad et al 13 Included studies were graded in 3 categories: randomization, comparability, and outcome.…”

Section: Quality Assessmentmentioning

confidence: 99%

Section: Effect On Transfusion Ratementioning

confidence: 99%

“…Thirteen 3,4,6,8,11,12,14,16,18,[21][22][23]30 studies (n = 2118; cell saver/control = 1078/1040) reported on the number of patients transfused in each group. Eight studies 4,6,8,11,14,[21][22][23] (n = 1205; cell saver/control = 444/761) reported data on intraoperative transfusion rate. The cell saver group did not show a significant difference in intraoperative transfusion rates (OR 0.66 [95% CI 0.30, 1.41]; p = 0.28; I 2 = 81%).…”

Section: Effect On Transfusion Ratementioning

confidence: 99%

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

Cheriyan

Dua

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEIntraoperative 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.METHODSBoth 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.RESULTSEighteen 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.CONCLUSIONSCell 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.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: meta-analysis; strength of recommendation: low.

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“…Furthermore, the worldwide crisis in blood supply and an increase in the number of procedures that require a high supply of blood as well as more advanced filtration and testing methods, which increase the cost of a unit of blood, warrant the need for other alternatives. As more data are being collected on the value of blood conservation in spine surgery, more demand is being placed on already scarce perfusion resources [ 11 – 13 ]. One method of blood conservation employed in the spine surgery is cell saver [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Cell salvage within adult and pediatric idiopathic scoliosis surgery: A random cross-sectional study

Al-Mohrej

Al-Torbaq

Hshem

et al. 2020

SICOT-J

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Introduction: This study aimed to evaluate the use of a cell savage and its impact on the amount of allogenic blood transfused to the patients during idiopathic scoliosis surgery. Methods: A total of 142 randomly selected patients with scoliosis had been included in this study. The adult group consisted of 78 patients, and the pediatric group, 64 patients. Both groups were divided into subgroups (pre-cell saver era and cell saver era). Data on the following parameters were collected: amount of blood transfused intraoperatively, within 24 h postoperatively, and overall. The number of patients who received transfusion was counted as the number of patients who avoided any transfusion. For statistical purposes, we performed unpaired student t-test, chi-square test, and Mann–Whitney test. Results: There was no significant difference in adult groups perioperatively. In the pediatric group, there was a statistically significant difference intraoperatively. Economic analysis of blood management showed positive numbers for both groups, where more than 1 unit of blood was transfused. Conclusions: Statistical analysis showed the cost-effectiveness of the perioperative use of cell salvage during pediatric scoliosis surgery. Overall, the use of cell salvage during scoliosis surgery had a positive impact on both blood management and patient recovery.

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Randomized trial of Cell Saver in 2- to 3-level lumbar instrumented posterior fusions

Cited by 9 publications

References 22 publications

Clinical and Radiographic Comparison Between Open Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion With Bilateral Facetectomies

Clinical and Radiographic Comparison Between Open Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion With Bilateral Facetectomies

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

Cell salvage within adult and pediatric idiopathic scoliosis surgery: A random cross-sectional study

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