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Decrease Homologous Blood Transfusions in Adult Spinal Deformity Surgery?

OrthoSpineNews reports on the findings owhich evaluated postoperative blood salvage and autotransfusion against traditional closed suction drainage to see which one is superior in reducing the rate of homologous blood transfusions in adult spinal deformity patients.

HSS spine surgeon Evan D. Sheha, MD explained the rationale for conducting the study. “Given the significant blood loss associated with spinal deformity surgery and the inherent risks of allogeneic blood transfusion, the use of intraoperative cell salvage as a means to reduce the incidence of postoperative homologous transfusion has been shown to be both clinically and cost effective and is routinely used at our institution. However, at the time this study was conceived, the theoretical advantages of postoperative cell salvage and reinfusion – i.e. decreased risk of blood-borne disease transmission or surgical site infection, transfusion reaction, cost, etc. – in spinal deformity surgery had not been studied.”

A total of 34 patients who had long posterior fusions were randomized to Group 1 (a blood salvage and reinfusion system known as OrthoPat), while 35 patients’ surgeries involved a standard subfascial closed suction drain (Group 2). The researchers found no differences in preoperative or intraoperative parameters. However, there was no significant difference in the percentage of patients requiring homologous blood transfusion between the two groups (41% Group 1 vs. 60% Group 2, P1⁄40.17). Similarly, a subgroup analysis in patients with estimated blood loss >2000mL also showed no difference in homologous blood transfusion rates (67% Group 1 vs. 76% Group 2, P1⁄40.58). There were no differences in the rate or type of postoperative complications.

Han Jo Kim, MD, spine surgeon at HSS and co-author of the study added, “The debate primarily surrounds the cost effectiveness of using postoperative blood salvage, but that is assuming, of course, that it confers a clinical benefit. Despite the theoretical benefits of postoperative blood salvage and retransfusion, we found no significant difference in either the rates of postoperative allogeneic transfusion or the amount of blood transfused between the two groups.”

“As both perioperative blood conservation strategies and blood salvage technology will continue to evolve, our findings should not preclude the future study of postoperative blood salvage and reinfusion in spine surgery,” added Dr. Sheha.

Read the full article at Orthospinenews.com.