The use of cell salvage in routine cardiac surgery is ineffective and not cost-effective and should be reserved for selected cases

Attaran, Saina; McIlroy, Daniel J.; Fabri, Brian M.; Pullan, Mark

doi:10.1510/icvts.2010.249136

Cited by 26 publications

(36 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Attaran et al [19], in a group of 1871 patients using CS, obtained percentage of re-exploration for bleeding that varied with the type of surgery, similar to that shown previously. These authors also concluded that regular use of CS does not bring any benefit to the patient, and this decision should be made individually.…”

Section: Discussionsupporting

confidence: 74%

“…The higher cost was observed in Group B, R$ 394.00 more. Several authors have also come to this conclusion [7][8][9]11] and, therefore, its indication has been made for specific cases in which bleeding is above normal [10]. However, we must take into consideration that the group using CS, 28 patients did not have UPRBC infusionn infusion, the total of 1.25 RBC / patient / hospitalization, and in Group A, 4.31.…”

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

“…The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists [4], in its guidelines for 2007, considered as class I the use of CS. However, several authors have shown that the use of CS is not as beneficial as stated [5,6] and is not cost-effective [7][8][9].In order to clarify this issue, the authors devised this work, which aims to verify that the primary use of CS in cardiovascular surgery with cardiopulmonary bypass (CPB), is cost-effective. As a secondary objective, we sought to identify a reduction in the use of units of UPRBC in patients who used CS, and morbidity resulting from the use of this protocol.…”

mentioning

confidence: 99%

See 3 more Smart Citations

The use of cell saver system in cardiac surgery with cardiopulmonary bypass

Almeida¹,

Leitão²

2013

Revista Brasileira De Cirurgia Cardiovascular

View full text Add to dashboard Cite

Rev Bras Cir Cardiovasc 2013;28(1):76- Abstract Introduction: The use of cell saver (CS) in cardiac surgery is proposed to reduce the use of units of packed red blood cells stored (UPRBC), which increases morbidity, mortality and causes inflammatory reactions.Objective: The objective is to evaluate whether the use of CS decreases the use UPRBC, is cost / effective and beneficial to the patient.Methods: In a prospective study, between November 2009 and October 2011, 100 consecutive patients who underwent cardiovascular surgery with CPB, hemodilution and hemofiltration, were enrolled. Patients were divided into group 1 (no CS) and 2 (CS). The criteria for the replacement of RBC were hemodynamic instability and hemoglobin (Hb) <7-8g/dl. Demographic data, as well as Hb and hematocrit, mediastinal drainage, number of URBC and CPB, ICU and hospital time, were analysed.Results: In groups 1 and 2 the average age was 64.1 and 60.6 years; predominantly male; the logistic EuroSCORE 10.3 and 9.4; mortality 2% and 4%. Group 2 had a higher incidence of reoperations (12% versus 6%), but the average of UPRBC used (4.31 versus 1.25) and mean length of hospital stay (10.8 versus 7.4 days) was lower. Univariate and multivariate analysis, were performed, which showed no statistically significant values, except in the use of UPRBC. The relationship between the CS and the cost of RBC was not cost / effective and length of stay was shorter.Conclusion: The use of CS decreases the number of used UPRBC, is not cost / effective but has shown benefits for patients. Descriptors INTRODUCTIONSeveral methods have been used to decrease the use of homologous blood with the progress and increased knowledge of the pathophysiology of cardiopulmonary bypass. This has been a path, with the highest incidence of use in patients for religious reasons and those who do not wish to make use of units of stored packed red blood cells (UPRBC). The use of this strategy varies from services to services in different continents, between 15% and 60% [1].In recent years, efforts have been made to decrease more and more the use of homologous blood, with recovery of autologous blood during surgery and sometimes even in the postoperative period [2], along with a more hemostasis strict protocols throughout the surgical procedures. Cell savers machines (CS) have been used [3] in adult patients with high risk of bleeding, due to the fact that they decrease the inflammatory response to cardiopulmonary bypass. The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists [4], in its guidelines for 2007, considered as class I the use of CS. However, several authors have shown that the use of CS is not as beneficial as stated [5,6] and is not cost-effective [7][8][9].In order to clarify this issue, the authors devised this work, which aims to verify that the primary use of CS in cardiovascular surgery with cardiopulmonary bypass (CPB), is cost-effective. As a secondary objective, we sought to identify a reduction in the use of units of UPRBC in patien...

show abstract

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

The use of cell saver system in cardiac surgery with cardiopulmonary bypass

Almeida¹,

Leitão²

2013

Revista Brasileira De Cirurgia Cardiovascular

View full text Add to dashboard Cite

show abstract

“…This was consistent with the literature (21,22). However, CSS should always be considered particularly for patients having a low preoperative haemoglobin level and patients who experienced side effects in previous blood transfusions.…”

Section: Discussionsupporting

confidence: 94%

Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

Bilgili

Erçin

Peker³

et al. 2014

Balkan Med J

View full text Add to dashboard Cite

Blood loss and replacement during surgery is a controversial issue in major orthopaedic surgery such as Total Knee Arthroplasty (TKA). Allogeneic blood transfusion causes legal problems and concerns in terms of transmission of transfusion-related diseases. Therefore, cell saver systems (CSS) were developed to minimize the need for allogeneic blood transfusion. However, contradictory results have arisen from studies examining the use of CSS to reduce the need for allogeneic blood transfusion in primary TKA (1-3). Additionally, transfusion by CSS may also cause coagulation, infection and haemodynamic instability (4). The autologous blood should be used within 6 hours in order to prevent potential contamination and febrile reactions (5-7).This study investigated the effect of CSS use on levels of allogeneic blood transfusion in TKA patients and the associated costs. An attempt was also made to determine the factors predicting the need for allogeneic blood transfusion. MATERIAL AND METHODFollowing approval from the Ethics Committee of our hospital and having informed consent by all patients, patients undergoing unilateral, cemented TKA for primary knee osteoarthritis between January 2012 and June 2013 in our clinic were retrospectively evaluated. In Group 1, 37 patients were treated with a CSS, and in Group 2, 39 patients were given allogeneic blood transfusion. Simultaneous bilateral TKA cases, revision surgery and missing medical record cases were excluded from the study. Patients who had inflammatory arthritis, haematological disease, post-operatively developing myocardial Background: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Aims: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Study Design: Retrospective comparative study. Methods: Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. Results:No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05) and cost was higher in Group 1 (p<0.05). Conclusion: Cell saver systems do not decre...

show abstract