Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study

Abstract

BackgroundA relatively new method of electrocautery, the radiofrequency bipolar hemostatic sealer (RBHS), uses saline-cooled delivery of energy, which seals blood vessels rather than burning them. We assessed the benefits of RBHS as a blood conservation strategy in adult patients undergoing multilevel spinal fusion surgery.MethodsIn a retrospective cohort study, we compared blood utilization in 36 patients undergoing multilevel spinal fusion surgery with RBHS (Aquamantys®, Medtronic, Minneapolis, MN, USA) to that of a historical control group (n = 38) matched for variables related to blood loss. Transfusion-related costs were calculated by two methods.ResultsPatient characteristics in the two groups were similar. Intraoperatively, blood loss was 55% less in the RBHS group than in the control group (810 ± 530 vs. 1,800 ± 1,600 mL; p = 0.002), and over the entire hospital stay, red cell utilization was 51% less (2.4 ± 3.4 vs. 4.9 ± 4.5 units/patient; p = 0.01) and plasma use was 56% less (1.1 ± 2.4 vs. 2.5 ± 3.4 units/patient; p = 0.03) in the RBHS group. Platelet use was 0.1 ± 0.5 and 0.3 ± 0.6 units/patient in the RBHS and control groups, respectively (p = 0.07). The perioperative decrease in hemoglobin was less in the RBHS group than in the control group (−2.0 ± 2.2 vs. –3.2 ± 2.1 g/dL; p = 0.04), and hemoglobin at discharge was higher in the RBHS group (10.5 ± 1.4 vs. 9.7 ± 0.9 g/dL; p = 0.01). The estimated transfusion-related cost savings were $745/case by acquisition cost and approximately 3- to 5-fold this amount by activity-based cost.ConclusionsThe use of RBHS in patients undergoing multilevel spine fusion surgery can conserve blood, promote higher hemoglobin levels, and reduce transfusion-related costs.

The Aquamantys® system improves haemostasis and pneumostasis in open decortication for thoracic empyema

“…It has been proven also to reduce blood loss and improve visualization during spinal surgery (8,14,19). A recent report of its application in brain tumour resection has demonstrated similar benefits in terms of reducing blood loss.…”

“…The combination of RF energy and saline provides haemostatic sealing of tissues, without charring or carbonisation. It has been widely adopted in a number of other surgical specialties, including orthopaedic, hepatobiliary and neurosurgery (8)(9)(10). Reports in the literature of the use of the Aquamantys ® system in a thoracic surgical setting are limited and deal with older, lower-energy models of the device that proved inefficient at sealing lung tissue (11,12).…”

Spinal cord stimulation: a review of the safety literature and proposal for perioperative evaluation and management

“…For spine surgeons, the Aquamantys System (Medtronic, Minneapolis, MN, USA) has grown in popularity after studies have shown its efficacy in the reduction in surgical blood loss and transfusion rates [38][39][40]. This device uses bipolar RF energy combined with saline irrigation to deliver controlled thermal energy to the soft tissues.…”

Bloodless medicine: current strategies and emerging treatment paradigms

“…Newer methods of electrocautery that more effectively achieve hemostasis, along with topical hemostatic agents and sealants, are also effective in reducing blood loss . In procedures expected to be associated with significant blood loss, we use autologous normovolemic hemodilution (ANH), although this method is most helpful in cardiac surgery, because patients benefit from the fresh whole blood with functional clotting factors and PLTs after separation from cardiopulmonary bypass .…”