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Predictive Factors for the Use of Autologous Cell Saver Transfusion in Lumbar Spinal Surgery

Owens, Roger Kirk II MD; Crawford, Charles H. III MD; Djurasovic, Mladen MD; Canan, Chelsea E. MPH; Burke, Lauren O. MPH; Bratcher, Kelly R. RN, CCRP; McCarthy, Kathryn J. MD; Carreon, Leah Yacat MD, MSc

doi: 10.1097/BRS.0b013e31827f044e
Diagnostics

Study Design. Retrospective review.

Objective. To identify risk factors for cell saver transfusion in lumbar spinal surgery and determine if cell saver transfusions affected intraoperative or postoperative transfusion rates.

Summary of Background Data. Cell saver has been used to minimize allogeneic blood transfusion in lumbar spinal surgery. Conflicting reports exist, which call into question the efficacy of cell saver use.

Methods. We reviewed medical records of randomly selected patients who underwent posterolateral fusion with or without transforaminal interbody fusion from July 2010 to June 2011. Transfusion rates and transfusion-related complications were determined. Binary logistic regression was performed to identify risk factors for use of autologous cell saver transfusion.

Results. There were 178 females and 107 males, with a mean age of 57.2 years. Of the 285 cases, 39 had no cell saver available, 147 had cell saver available but no autologous blood was recovered or transfused and 99 had an autologous cell saver transfusion. Patients who had cell saver transfusion had a higher rate of intraoperative allogeneic blood transfusion (52%) compared with those who did not (22%). There was no significant difference in the rate of postoperative transfusions or transfusion-related reactions between patients who did and did not have cell saver transfusion. Patient's age, smoking status, American Society of Anesthesiologists grade, use of anticoagulants preoperatively, primary or revision surgery, iliac crest bone graft harvest, anesthesiologist, or surgeon had no significant effect on cell saver infusion. Body mass index (odds ratio [OR] = 1.06), number of posterolateral fusion levels fused (OR = 2.50), and number of transforaminal interbody fusions performed (OR = 2.41) were independent risk factors for the use of autologous cell saver transfusion.

Conclusion. Body mass index, multi-level fusion and transforaminal interbody fusion result in increased use of autologous cell saver transfusion in lumbar spinal surgery. Use of autologous cell saver transfusion did not reduce the requirement for intraoperative or postoperative allogeneic blood transfusion.

Level of Evidence: 2

In 285 patients who underwent posterolateral fusion, body mass index (odds ratio [OR] = 1.06), number of levels fused (OR = 2.50), and number of transforaminal interbody fusions performed (OR = 2.41) were independent risk factors for autologous cell saver transfusion. Autologous cell saver transfusion did not reduce the requirement for intraoperative or postoperative allogeneic transfusion.

From the Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY.

Address correspondence and reprint requests to Leah Y. Carreon, MD, MSc, Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202; E-mail: leah.carreon@nortonhealthcare.org

Acknowledgment date: June 27, 2012. First revision date: October 15, 2012. Second revision date: November 16, 2012. Acceptance date: November 17, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, payment for lecture.

© 2013 Lippincott Williams & Wilkins, Inc.