The Development of Cell Salvage as a Technique within Adult and Pediatric Spinal Surgery - A Small Retrospective Study

Abstract

Introduction Cell salvage is currently one of the main methods for blood conservation peri-operatively. This procedure derives the red cells from suctioned blood, washes them and re-suspends the cells in saline which allows the red cells to be transfused back to the patient. The aim of this study was to evaluate the use of a cell saver peri-operative management and its impact on amount of allogenic blood transfused to the patients during adult and pediatric spine surgeries. This is a retrospective study which reviews data of patients who underwent spine surgery during the years 2010 to 2012 at King Faisal Specialist Hospital and Research Centre in Riyadh. Material and Method: A total number of 142 spine surgery patients had been included in this study. The adult group consisted of 78 patients who were further divided into group A (39 pt.) without use of cell saver peri-operatively and group B (39 pt.) with use of cell saver. In the pediatric group there were 64 patients. Group A (32 pt.) relayed solely on use of allogenic blood from blood bank, patients in group B (32 pt.) used cell saver peri-operatively. The machines used were a mix of Haemonetics Corps Cell Saver 5 and Haemonetics 5. The size of recuperation bowl we used were 70ml, 125 ml and 225ml. Swabs washing was also instituted to improve the yield. The parameters collected were the amount of blood transfused intra-operatively, within 24 hours post-operatively and as a total. The number of patients who received transfusion was counted as well as number of patients who were able to avoid any transfusion. Considering the cost effectiveness of blood management we have estimated our results on the cost of cell saver disposable and price per unit of blood in the year 2012. For statistical purpose we had chosen unpaired student t-test, chi squared test and the Mann Whitney test. Results There had been found no statistically significant difference in the groups A and B of the Adult group intra-operatively, post-operatively and as a total by analyzing the use of blood. In parameters showing the avoidance of transfusions there had been also found no statistically significant differences. In the Pediatric group of patients there was found to be statistically significant difference between groups A and B during intra-operative phase and as a total. Post-operatively there was no significant difference in the blood use. The same applies to the avoidance of transfusions. Economical analysis of the blood management showed positive numbers for both groups – Adult and Pediatric, when more than 1 unit of blood was to be transfused. Conclusions Statistical analysis had discovered efficacy and cost effectiveness of peri-operative use of cell salvage during Pediatric spine surgery. Its efficacy, concerning our data, in the Adult spine surgery is questionable. But if taken on a whole the use of cell salvage within spine surgery had been seen to have positive impact on both blood management and patient's recovery.