Efficacy and cost considerations of intraoperative autologous transfusion in spinal fusion for idiopathic scoliosis with predeposited blood.

STUDY DESIGN

One hundred five patients with adolescent idiopathic scoliosis who underwent posterior spinal instrumentation and fusion with predeposited autologous blood, with or without intraoperative autologous transfusion, were reviewed.

OBJECTIVE

To determine the benefit/nonbenefit of intraoperative autologous transfusion in diminishing the need for homologous blood and influencing post-operative hematocrit values in healthy adolescents undergoing spinal fusion for scoliosis.

SUMMARY OF BACKGROUND DATA

A steady increase in the use of intraoperative autologous transfusion in recent years has occurred without guidelines regarding which procedures and patient populations would be best served. Previous studies have failed to determine the cost effectiveness and actual reduction in homologous blood exposure attributable to intraoperative autologous transfusion in adolescents who have undergone preoperative phlebotomy.

METHODS

Fifty-five adolescents (intraoperative autologous transfusion group) who underwent posterior instrumentation and fusion for idiopathic scoliosis with the use of an intraoperative autologous transfusion device were compared to 50 patients (control group) who underwent the same procedure without the intraoperative autologous transfusion device.

RESULTS

The average percent salvage of red blood cells by the intraoperative autologous transfusion device was 35%. The control group utilized significantly more of the predonated autologous blood than the intraoperative autologous transfusion group (1.34 units/case vs. 1.78 units/case, P < 0.05). Homologous blood usage was the same in both groups. Two patients in the intraoperative autologous transfusion group required nondirected homologous blood (total of four units), compared to three patients in the control group (total of four units) (P = 0.048). Using multiple regression analysis, the total number of transfusions was significantly correlated with the estimated blood loss and the duration of surgery in both groups. Postoperative hematocrit levels were slightly higher in the control group, but there was not a significant difference.

CONCLUSIONS

The addition of intraoperative autologous transfusion to a preoperative phlebotomy program had no benefit on homologous blood exposure or post-operative hematocrit changes in this population. Blood requirements for this procedure can be met less expensively and more reliably by merely donating one's own blood.