Cost effectiveness of intraoperative autotransfusion in total hip arthroplasty surgery.

The purpose of this study was to analyze the cost effectiveness of the cell saver in reducing homologous blood transfusion requirements in patients undergoing primary total hip arthroplasties. In patients who had predonated autologous blood, the addition of the cell saver neither reduced the homologous blood requirements nor the percentage of patients exposed to banked blood. In patients without predonated autologous blood, the cell saver decreased the percentage of patients exposed to banked blood by 40% and decreased the mean homologous transfusion requirement from 2.6 to 1.5 units per patient (p < 0.05). The cell saver became cost effective when 3 units of blood were salvaged. Because the cell saver reclaimed a mean of 453 ml (approximately 2 units), it was not cost effective. This analysis is confounded by the risk of exposure to blood borne potentially life-threatening pathogens. In patients undergoing elective primary hip arthroplasty, the availability of predonated autologous blood obviates the need for expensive intraoperative blood salvage techniques. If an adequate volume of autologous blood cannot be procured preoperatively, or if the clinician suspects excessive intraoperative bleeding, then using the cell saver may be justified.