Clinical efficacy and cost effectiveness of intraoperative cell salvage in pelvic trauma surgery

Abstract

INTRODUCTION Pelvic acetabular injuries are associated with significant blood loss. This is compounded by multiple surgical interventions including definitive fracture fixation, which put patients at further risk of postoperative transfusion. We use intraoperative cell salvage routinely as a blood conservation strategy to address this issue. This is a prospective evaluation of the clinical efficacy and cost effectiveness of using intraoperative cell salvage in patients with pelvic acetabular injuries. METHODS Data were collected prospectively for all the patients who underwent pelvic acetabular fracture fixation at our institution. A total of 30 patients (25 men, 5 women) with a mean age of 41 years (range: 31-79 years) were assessed over a period of 10 months. RESULTS The mean preoperative and postoperative haemoglobin levels were 11.8g/dl and 9.9g/dl respectively. The mean intraoperative blood loss was 1,232.5ml (range: 150-2,693ml). The mean amount of blood salvaged and retransfused through a cell saver was 388ml. Of the 30 patients, 14 (47%) required transfusion after surgery and 26 units of blood were transfused. In terms of cost effectiveness, a total of £2,572 in 30 patients or £86 per patient were saved. CONCLUSIONS We found intraoperative cell salvage to be clinically efficacious and cost effective in patients with pelvic acetabular injuries.

Intraoperative cell salvage use reduces the rate of perioperative allogenic blood transfusion in patients undergoing periacetabular osteotomy

“…Although the influence of CS use on perioperative transfusion requirements in patients undergoing PAO has not previously been addressed, our results are in concordance with multiple previous studies of patients undergoing comparable orthopedic procedures, such as revision hip arthroplasty [33, 34] and acetabular fracture fixation [35, 36]. A Cochrane review of 21 randomized, controlled trials by Carless et al .…”

“…Odak et al . [35] presented their prospective review of 30 patients undergoing pelvic acetabular fracture fixation. In their study population, 47% required allogenic blood transfusion, and a statistically significant inverse relationship existed between volume of CS transfusion and postoperative allogenic transfusion requirement.…”

“…There is good evidence to support the use of CS systems in patients undergoing hip and knee arthroplasty [29–32], revision hip arthroplasty [33, 34], and acetabular fracture fixation [35, 36]; however, research on the efficacy of CS use on transfusion requirements in spinal surgery has yielded conflicting results [37–39]. There are currently no studies investigating the impact of CS on perioperative allogenic transfusion requirements in patients undergoing PAO.…”

Association of Anaesthetists guidelines: cell salvage for peri‐operative blood conservation 2018

“…It concluded that CS in this setting reduces blood transfusion and is cost effective. Prospective data for 30 patients undergoing pelvic acetabular fracture fixation found a mean blood loss of 1233 ml and an average of 388 ml retransfused through CS; only 47% of patients required allogeneic transfusion. In a combat hospital, a CS feasibility study concluded that CS was most successful in patients with gunshot wounds and cavity injuries compared with limb or blast injuries .…”

Impact of Blood Transfusion During Definitive Stabilization Surgeries on Pelvic Fracture Patient Clinical Outcomes

“…Studies on the intraoperative transfusion strategies during orthopaedic xation surgeries were mostly about autologous blood transfusion and its outcome [7,8], the impact of the intraoperative allogeneic blood transfusion on de nitive stabilization surgeries of pelvic fracture patients has not been discussed and still remains unclear. Multiple factors can affect the intraoperative blood transfusion, such as the coagulation function, the estimated blood loss, the type of surgery, and the traumatic condition.…”