title: The Cell Saver in adult lumbar fusion surgery: a cost-benefit outcomes study.
abstract: METHODS
  Review of efficacy of Cell Saver in a nonrandomized group of patients undergoing lumbar fusion.
  
  
  OBJECTIVE
  Determine the necessity and cost-effectiveness of the use of Cell Saver for adult lumbar spine fusions.
  
  
  BACKGROUND
  Specific indications for the use of Cell Saver in adult lumbar fusion surgery have not been clearly determined. In addition to effectiveness in blood replacement, the economic benefits of the Cell Saver have not been evaluated.
  
  
  METHODS
  A total of 102 consecutive cases of posterolateral fusion with internal fixation were reviewed retrospectively. There were 56 patients in the Cell Saver group and 46 patients in the control group. Recorded hospital medical and financial data were analyzed for each patient.
  
  
  RESULTS
  There was a 38% recovery rate of blood using the Cell Saver. This resulted in a decreased need for postoperative transfusion in the study group (1 U to 36% of patients) relative to the control group (1 U to 50% of patients). Significant predictors for surgery time were the number of levels fused (P < 0.0001), patient's weight (P = 0.0030), and use of Cell Saver (P = 0.0472). Significant indicators of blood loss were the number of levels fused (P < 0.0001) and surgical time (P = 0.0304). The average cost for blood-related charges in the Cell Saver group was 512 dollars versus 270 dollars per patient in the control group. CONCLUSIONS.: While the Cell Saver group did require fewer postoperative transfusions, the difference was not as much as expected. In elective fusions for degenerative conditions of the lumbar spine, blood requirements can usually be satisfied with predonation of autologous blood. With contemporary practices of predonation, the use of the Cell Saver appears to be neither necessary nor cost-effective during most elective lumbar fusions.
authors.affiliation: Department of Orthopedic Surgery, Baylor College of Medicine, Saint Luke's Episcopal Hospital, Houston, TX, USA. creitman@bcm.tmc.edu
authors.forename: Charles A
authors.initials: CA
authors.lastname: Reitman
authors.forename: William C
authors.initials: WC
authors.lastname: Watters
authors.forename: Walter R
authors.initials: WR
authors.lastname: Sassard
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D001804:Blood Transfusion, Autologous / Q000191:economics / Q000295:instrumentation* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures / Q000191:economics; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007430:Intraoperative Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics; D016896:Treatment Outcome