Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY.
Spine (Phila Pa 1976). 2023 Sep 1;48(17):1234-1244. doi: 10.1097/BRS.0000000000004743. Epub 2023 Jun 7.
A retrospective, propensity-matched observational study.
To assess the impact of cell saver (CS) homologous transfusion on perioperative medical complications in adult patients undergoing spinal deformity surgery.
Despite many endorsing its use, many analyses still refute the efficacy of CS on decreasing total perioperative allogenic red blood cell transfusions, cost efficiency, and its effect on perioperative complications.
Adult patients who underwent spinal deformity surgery at a single center between 2015 and 2021 were retrospectively reviewed. Patient-specific, operative, radiographic, and 30-day complications/readmission data were collected for further analysis. Two methods were utilized to test our hypothesis: (1) absolute threshold model: two cohorts created among patients who received ≥550 mL of CS intraoperatively and those who received less; (2) adjusted ratio model: two cohorts created dependent on the ratio of CS to estimated blood loss (EBL). Propensity-score matching and various statistical tests were utilized to test the association between CS and perioperative medical complications.
Two hundred seventy-eight patients were included in this analysis with a mean age of 61.3±15.7yrs and 67.6% being female. Using the first method, 73 patients received ≥550 mL of CS, and 205 received less. Propensity-score matching resulted in 28 pairs of patients. 39.3% of patients with ≥550 mL CS required readmission within 30 days compared with 3.57% of patients in the <550 mL cohort ( P =0.016), despite a nearly identical proportion of patients requiring intraoperative blood transfusions ( P >0.9999). Using the second method, 155 patients had CS/EBL<0.33 and 123 with CS/EBL ≥0.33. 5.16% and 21.9% among patients with CS/EBL<0.33 and CS/EBL≥0.33, respectively, were readmitted by the 30-day marker ( P <0.0001).
Our findings indicate that greater CS volumes transfused are associated with higher rates of 30-day readmissions. Thus, surgeons should consider limiting CS volume intraoperatively to 550 mL and when greater volumes are required or preferred, ensuring that the ratio of CS:EBL remains under 0.33.
回顾性、倾向匹配的观察性研究。
评估在接受脊柱畸形手术的成年患者中，使用细胞保存（CS）同种异体输血对围手术期医疗并发症的影响。
尽管许多人支持其使用，但许多分析仍然反驳了 CS 减少围手术期全血异体红细胞输血、成本效率以及对围手术期并发症影响的功效。
对 2015 年至 2021 年间在单一中心接受脊柱畸形手术的成年患者进行回顾性研究。收集患者特定的、手术的、影像学的和 30 天并发症/再入院数据进行进一步分析。使用两种方法检验我们的假设：（1）绝对阈值模型：创建两个队列，一个是术中接受≥550ml CS 的患者，另一个是接受少于 550ml CS 的患者；（2）调整比例模型：创建两个依赖于 CS 与估计失血量（EBL）比例的队列。使用倾向评分匹配和各种统计检验来检验 CS 与围手术期医疗并发症之间的关联。
本分析纳入 278 例患者，平均年龄为 61.3±15.7 岁，其中 67.6%为女性。使用第一种方法，73 例患者接受了≥550ml CS，205 例患者接受了少于 550ml CS。倾向性评分匹配产生了 28 对患者。接受≥550ml CS 的患者中，有 39.3%在 30 天内需要再次入院，而接受<550ml CS 的患者中，有 3.57%需要再次入院（P=0.016），尽管接受术中输血的患者比例几乎相同（P>0.9999）。使用第二种方法，155 例患者 CS/EBL<0.33，123 例患者 CS/EBL≥0.33。CS/EBL<0.33 的患者中，有 5.16%在 30 天标记时需要再次入院，CS/EBL≥0.33 的患者中，有 21.9%需要再次入院（P<0.0001）。
我们的发现表明，输注更多的 CS 体积与更高的 30 天再入院率相关。因此，外科医生应考虑将术中 CS 体积限制在 550ml 以内，当需要或更倾向于使用更大体积时，确保 CS:EBL 的比值低于 0.33。
