title: A cost study of postoperative cell salvage in the setting of elective primary hip and knee arthroplasty.
abstract: BACKGROUND
  The increasing costs, limited supply, and clinical risks associated with allogeneic blood transfusion have prompted investigation into autologous blood management strategies, such as postoperative red blood cell (RBC) salvage. This study provides a cost comparison of transfusing washed postoperatively salvaged RBCs using an orthopedic perioperative autotransfusion device (OrthoPat, Haemonetics Corporation) versus unwashed shed blood and banked allogeneic blood.
  
  
  METHODS
  Cell salvage data were retrospectively reviewed for a sample of 392 patients who underwent primary hip or knee arthroplasty. Mean unit costs were calculated for washed salvaged RBCs, equivalent units of unwashed shed blood, and therapeutically equivalent volumes of allogeneic RBCs.
  
  
  RESULTS
  No initial capital investment was required for the establishment of the postoperative cell salvage program. For patients undergoing total knee arthroplasty (TKA), the mean unit costs for washed postoperatively salvaged cells, unwashed shed blood, and allogeneic banked blood were $758.80, $474.95, and $765.49, respectively. In patients undergoing total hip arthroplasty (THA), the mean unit costs for washed postoperatively salvaged cells, unwashed shed blood, and allogeneic banked blood were $1827.41, $1167.41, and $2609.44, respectively.
  
  
  CONCLUSIONS
  This analysis suggests that transfusing washed postoperatively salvaged cells using the OrthoPat device is more costly than using unwashed shed blood in both THA and TKA. When compared to allogeneic transfusion, washed postoperatively salvaged cells carry a comparable cost in TKA, but potentially represent a significant savings in patients undergoing THA. Sensitivity analysis suggests that in the case of TKA, however, cost comparability exists within a narrow range of units collected and infused.
authors.affiliation: Department of Anesthesiology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Vidya K
authors.initials: VK
authors.lastname: Rao
authors.forename: Robert
authors.initials: R
authors.lastname: Dyga
authors.forename: Christopher
authors.initials: C
authors.lastname: Bartels
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Waters
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D001804:Blood Transfusion, Autologous / Q000009:adverse effects / Q000191:economics*; D002201:Capital Expenditures / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000191:economics; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D057725:Operative Blood Salvage / Q000009:adverse effects / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies