Intraoperative Red Blood Cell Salvage in Posterior Spinal Fusions for Idiopathic Scoliosis: Identifying Potential Criteria for Selective Use

Study design

Retrospective.

Objectives

Evaluate the role and effectiveness of ICS in primary posterior spinal fusion (PSF) for idiopathic scoliosis (IS).

Summary of background data

Intraoperative cell salvage (ICS) minimizes blood loss and need for allogeneic transfusions. However, it adds substantial charges ($800–1200 US) and may be of less clinical benefit in some PSF for IS.

Materials and methods

This was a single-hospital, retrospective analysis of 178 consecutive IS cases (10–18 years of age) who underwent primary PSF by a single pediatric spine surgeon.

Results

Overall, 41% of cases received a mean 167 cc of ICS blood, after a mean EBL of 528 mL (range 200–1800 mL). No blood was returned in 59% of cases, with a mean EBL of 293 mL (range 75–700 mL). Only 6.5% of the entire cohort received > / = 250 cc via ICS, after a mean EBL of 773 mL. A positive correlation exists between EBL and vertebral levels fused, preoperative major Cobb angle, and length of anesthesia (p < 0.001). ICS may be more efficacious at an inflection point of 12 vertebral fusion levels, preoperative major Cobb angles > / = 55°, anesthesia exposure > / = 6 h, and with use of posterior column osteotomies (PCOs) (p < 0.05). In addition, lack of tranexamic acid use lead to greater EBL (p < 0.0001) and ICS volumes (p = 0.008).

Conclusion

The use of ICS in IS patients undergoing PSF resulted in the return of > / = 250 cc of ICS blood (similar volume to one allogeneic unit) in only 6.5% of cases. Charges for ICS set-up and processing of one bowl of ICS is much higher than for one allogeneic unit ($1200 vs. $462 US), hence transfusing lower volumes of autologous ICS blood is not cost-effective for all PSF for IS.