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Blood Salvage Produces Higher Total Blood Product Costs in Single-Level Lumbar Spine Surgery

Canan, Chelsea E. MPH*,†; Myers, John A. MSPH, PhD; Owens, Roger Kirk MD*; Crawford, Charles H. III MD*; Djurasovic, Mladen MD*; Burke, Lauren O. MPH*; Bratcher, Kelly R. RN, CCRP*; McCarthy, Kathryn J. MD*; Carreon, Leah Y. MD, MSc*

doi: 10.1097/BRS.0b013e3182767c8c
Surgery

Study Design. Retrospective review.

Objective. To determine the incremental cost-effectiveness of cell saver for single-level posterior lumbar decompression and fusion (PLDF).

Summary of Background Data. Intraoperative cell salvage is used during surgery to reduce the need for perioperative allogeneic blood transfusion. Although the use of cell saver may be beneficial in certain circumstances, its utility has not been clearly established for the common procedure of an adult single-level PLDF.

Methods. Randomly selected adult patients treated with a single-level PLDF between July 2010 and June 2011 at a single institution were identified. Patients who had a combined anterior and posterior approach were excluded. The final study sample for analysis consisted of 180 patients. Hospital records were reviewed to determine whether: (1) cell saver was available during surgery, (2) recovered autologous blood was infused, and (3) the patient received intra- or postoperative allogeneic transfusions. Estimated blood loss, levels fused, volume(s) transfused, and all related complications were recorded. Costs included the cost of allogeneic blood transfusion, setting up the cell saver recovery system, and infusing autologous blood from cell saver, whereas effectiveness measures were allogeneic blood transfusions averted and quality adjusted life years.

Results. The incremental cost-effectiveness ratio was $55,538 per allogeneic transfusion averted, with a decrease in the transfusion rate from 40.0% to 38.7% associated with the cell saver approach. This translated into an incremental cost-effectiveness ratio of $5,555,380 per quality adjusted life years gained, which is well above the threshold for an intervention to be considered cost-effective ($100,000 per quality adjusted life years gained).

Conclusion. The use of cell saver during a single-level PLDF does not significantly reduce the need for allogeneic blood transfusion and is not cost-effective. The high cost of cell saver in combination with the low complication rate of allogeneic blood transfusion, suggest that cell saver should not be used for single-level PLDF. Further studies are needed to evaluate the necessity for cell saver among other types of spinal surgery.

The use of cell saver during a single-level posterolateral decompression and fusion does not significantly reduce the need for allogeneic blood transfusion and is not cost-effective, with an incremental cost-effectiveness ratio of $55,538 per allogeneic transfusion averted.

*Norton Leatherman Spine Center, Louisville, KY; and

University of Louisville School of Public Health and Information Sciences, Louisville, KY.

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

Acknowledgment date: July 17, 2012. First revision date: September 17, 2012. Second revision date: September 25, 2012. Acceptance date: September 26, 2012.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication. No funds were received in support of this work. Relevant financial activities outside the submitted work: consultancy, travel/accommodations/meeting expenses, payment for lectures, honoraria.

© 2013 Lippincott Williams & Wilkins, Inc.