Gum Jeffrey L, Carreon Leah Yacat, Kelly Michael P, Hostin Richard, Robinson Chessie, Burton Douglas C, Polly David W, Shaffrey Christopher I, LaFage Virginie, Schwab Frank J, Ames Christopher P, Kim Han Jo, Smith Justin S, Bess R Shay
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
Spine Deform. 2017 Jul;5(4):272-276. doi: 10.1016/j.jspd.2017.01.005.
Retrospective cohort.
To determine if the use of cell saver reduces overall blood costs in adult spinal deformity (ASD) surgery.
Recent studies have questioned the clinical value of cell saver during spine procedures.
ASD patients enrolled in a prospective, multicenter surgical database who had complete preoperative and surgical data were identified. Patients were stratified into (1) cell saver available during surgery, but no intraoperative autologous infusion (No Infusion group), or (2) cell saver available and received autologous infusion (Infusion group).
There were 427 patients in the Infusion group and 153 in the No infusion group. Patients in both groups had similar demographics. Mean autologous infusion volume was 698 mL. The Infusion group had a higher percentage of EBL relative to the estimated blood volume (42.2%) than the No Infusion group (19.6%, p < .000). Allogeneic transfusion was more common in the Infusion group (255/427, 60%) than the No Infusion group (67/153, 44%, p = .001). The number of allogeneic blood units transfused was also higher in the Infusion group (2.4) than the No Infusion group (1.7, p = .009). Total blood costs ranged from $396 to $2,146 in the No Infusion group and from $1,262 to $5,088 in the Infusion group. If the cost of cell saver blood was transformed into costs of allogeneic blood, total blood costs for the Infusion group would range from $840 to $5,418. Thus, cell saver use yielded a mean cost savings ranging from $330 to $422 (allogeneic blood averted). Linear regression showed that after an EBL of 614 mL, cell saver becomes cost-efficient.
Compared to transfusing allogeneic blood, cell saver autologous infusion did not reduce the proportion or the volume of allogeneic transfusion for patients undergoing surgery for adult spinal deformity. The use of cell saver becomes cost-efficient above an EBL of 614 mL, producing a cost savings of $330 to $422.
Level III.
回顾性队列研究。
确定使用血液回收机是否能降低成人脊柱畸形（ASD）手术的总体血液成本。
近期研究对脊柱手术中血液回收机的临床价值提出了质疑。
从一个前瞻性、多中心手术数据库中筛选出具有完整术前和手术数据的ASD患者。患者被分为两组：（1）手术中有血液回收机可用，但未进行术中自体输血（未输血组）；（2）手术中有血液回收机可用且接受了自体输血（输血组）。
输血组有427例患者，未输血组有153例患者。两组患者的人口统计学特征相似。平均自体输血量为698毫升。与未输血组（19.6%，p <.000）相比，输血组的估计失血量（EBL）占估计血容量的百分比更高（42.2%）。输血组的异体输血比未输血组更常见（255/427，60%对67/153，44%，p =.001）。输血组输注的异体血单位数量也高于未输血组（2.4对1.7，p =.009）。未输血组的总血液成本在396美元至2146美元之间，输血组在1262美元至5088美元之间。如果将血液回收机血液的成本转换为异体血的成本，输血组的总血液成本将在840美元至5418美元之间。因此，使用血液回收机平均节省成本330美元至422美元（避免了异体输血）。线性回归显示，在EBL达到614毫升后，血液回收机具有成本效益。
与输注异体血相比，血液回收机自体输血并未降低成人脊柱畸形手术患者的异体输血比例或输血量。在EBL超过614毫升时，使用血液回收机具有成本效益，可节省330美元至422美元的成本。
三级。
