Lightning Podiums: Value and Outcomes in Spinal Surgery - Room 801B

Presented by: K. Jegede

Author(s):

K. Jegede(1), A. Buckland(1), E. DelSole(1), P. Zhou(1), D. Vasquez-Montes(1), L. Steinmetz(1), C. Varlotta(1), N. Frangella(1), J. Goldstein(1), J. Bendo(1)

(1) New York University Langone Orthopedic Hospital, Division of Spinal Surgery, New York, NY, United States

Abstract

Introduction: Intraoperative blood loss is a challenge in spine surgery and can require allogeneic blood transfusion. Cell Saver (CS) as an adjunctive tool that may decrease the need for allogeneic transfusion. However, it is associated with significant cost, especially for cases where not enough blood is collected for reinfusion. The aim of this study was to identify surgical factors predictive of wasted CS use in an effort to increase the value for CS use in spinal surgery.

Methods: We retrospectively evaluated 316 patients who had CS use during spinal surgery over a 6-month period. Procedures were stratified by anatomic location, levels fused, levels decompressed, and approach. EBL, total CS reinfusion, total allogeneic blood transfusion, and total autologous blood transfusion were compared between groups using one-way ANOVA. Post-hoc analysis was performed using Sheffes test. Cost analysis was also performed. Stepwise linear regression analysis was used to formulate predictive equations to estimate EBL, the rate of reperfusion, and the need for CS.

Results: Using linear regression modeling, we formulated predictive equations to guide judicious cell saver use. EBL was predicted by number of levels fused, presence of an interbody device, and levels decompressed for posterior fusion (R=0.61, p< 0.001). We modeled that EBL = 157.52 + (150.798 x levels fused) + (70.876 x levels decompressed) + 281.167 if an interbody device was used. Using our model, we predicted the percentage of patients who will require a transfusion of at least 250 cc from CS. Our analysis included posterior fusion (PF) only, PF with interbody device usage, and Anterior/Posterior approach. 72.7% of patients undergoing a 3-level fusion with at least one interbody device will receive at least 250 cc of blood. 60.9% of patients undergoing a 3-level fusion without an interbody device received at least 250 cc of blood. The cost of 250 cc of blood is significantly cheaper than an equivalent CS amount. If less than 250 cc of CS was transfused, CS was not cost effective.

Conclusions: For most one and two-level spinal fusions, the routine use of CS does not yield a clinically significant volume of reinfusion and does not appear to be cost-effective. The value of CS use decreases with decreased levels of spinal fusion.