Toward the elimination of homologous blood use in elective lumbar spine surgery.

Two hundred twenty-four consecutive patients underwent elective posterior lumbar spinal surgery over a 3 1/2-year span at the University of Miami/Jackson Memorial Medical Center. Patients ranged in age from 17 to 87 years, and 58% were male. Fifty-eight patients underwent revision surgery, and 65 patients required fusions, including 35 necessitating internal fixation. One hundred seventy-four patients (78%) were requested to participate in a preoperatively donated autologous blood (PDAB) program. Six of these patients were excluded from participation, and 168 patients banked 425 U of autologous blood. Eighty percent of the patients participating in the PDAB program received some or all of their donated blood. Intraoperative blood salvage was used in 37% of cases. Seven patients received homologous blood: four in addition to salvaged and donated blood, two that were unable to donate blood due to positive hepatitis B serology, and one erroneously. The combined use of PDAB and intraoperative salvage program allowed autologous blood replacement to meet the total transfusion requirements of 96% of the patients who predeposited blood, including 94% of those undergoing spinal fusions. Autologous blood comprised 99% of the total blood replacement used in this series, and 95% of the patients requiring blood transfusions received only autologous blood. Establishment of a protocol judiciously using PDAB in conjunction with intraoperative blood salvage can result in virtual elimination of the need for homologous blood transfusion in elective lumbar spine surgery.