Cost benefits of intraoperative cell salvage in radical cystectomy

Abstract

Objective:We have looked into the clinical and financial benefits of using intra-operative cell salvage (ICS) as a method to reduce the amount of autologous blood transfusion (ABT) requirement for our radical cystectomy (RC) patients.Materials and Methods:Fifteen consecutive patients undergoing radical cystectomy received cell salvaged blood (ICS), while 15 did not (NCS). The cost of using the cell saver, number of homologous transfusions, survival, and recurrences were recorded and compared using paired t-test and chi-square test between the two groups. A Dideco Electa® (Sorin Group, Electa, Italy) cell saver machine was used for all the patients in the ICS group and leukocyte filters were used on the salvaged blood before the autologous transfusion.Results:The mean age was 63 years (53–72 years), 66 years (46–79 years) in ICS and NCS groups, respectively (P = 0.368). All 15 (100%) patients in the NCS group required an allogenic transfusion compared to 9/15 (60%) in the ICS group (P = 0.08). There was a significant reduction in the mean volume of allogenic blood transfused with the use of cell saver. Median follow-up was 23 and 21 months in the ICS and NCS group with 10 and 4 patients alive at last follow-up, respectively. There was a saving of 355 pounds per patient in the ICS group compared to the NCS group.Conclusion:Our initial study shows that cell savage is feasible and safe in patients undergoing radical cystectomy. It does not adversely affect the medium term outcome of patients undergoing RC and is also cost effective.

Intra‐operative cell salvage in urological surgery: a systematic review and meta‐analysis of comparative studies

“…In the setting of RC or PN, complication rates for groups receiving ICS or no blood conservation technique were 39.5% vs 40.5% and 21% vs 17% , respectively. Lastly, Ubee et al reported non‐cancer‐related post‐cystectomy peri‐operative mortality in both ICS (one death) and no blood conservation technique groups (two deaths).…”

“…All were observational studies, representing low‐level evidence. Eligible publications assessed patients undergoing open RRP (11 studies ), open RC (two studies ) and open PN (one study ). There were no studies on ICS during urological laparoscopic or robot‐assisted procedures, nor for other major urological procedures associated with high peri‐operative transfusion rates, such as retroperitoneal lymph node dissection.…”

Blood transfusion and hemostatic agents used during radical cystectomy

“…7 There is evidence to suggest that it is cost-effective, safe and may reduce the need for blood transfusion in both radical prostatectomy and radical cystectomy; however, many cystectomy patients are ineligible due to preoperative anemia. 7,15,16 Autologous blood banking involves blood donation prior to surgery, but is time consuming, inconvenient to the patient, and has a high discard rate. 16,17 Lastly, autologous blood recovery (CellSaver) is the reinfusion of blood lost during the operation, which is collected, filtered, washed, processed and re-transfused, but is controversial among urologists due to theoretical risks of cancer dissemination.…”

“…7,15,16 Autologous blood banking involves blood donation prior to surgery, but is time consuming, inconvenient to the patient, and has a high discard rate. 16,17 Lastly, autologous blood recovery (CellSaver) is the reinfusion of blood lost during the operation, which is collected, filtered, washed, processed and re-transfused, but is controversial among urologists due to theoretical risks of cancer dissemination. 16,18 Interestingly, experienced urologists use these techniques more commonly than less experienced surgeons.…”

“…16,17 Lastly, autologous blood recovery (CellSaver) is the reinfusion of blood lost during the operation, which is collected, filtered, washed, processed and re-transfused, but is controversial among urologists due to theoretical risks of cancer dissemination. 16,18 Interestingly, experienced urologists use these techniques more commonly than less experienced surgeons. The reasons for this association are unknown.…”