title: Blood salvage produces higher total blood product costs in single-level lumbar spine surgery.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  To determine the incremental cost-effectiveness of cell saver for single-level posterior lumbar decompression and fusion (PLDF).
  
  
  BACKGROUND
  Intraoperative cell salvage is used during surgery to reduce the need for perioperative allogeneic blood transfusion. Although the use of cell saver may be beneficial in certain circumstances, its utility has not been clearly established for the common procedure of an adult single-level PLDF.
  
  
  METHODS
  Randomly selected adult patients treated with a single-level PLDF between July 2010 and June 2011 at a single institution were identified. Patients who had a combined anterior and posterior approach were excluded. The final study sample for analysis consisted of 180 patients. Hospital records were reviewed to determine whether: (1) cell saver was available during surgery, (2) recovered autologous blood was infused, and (3) the patient received intra- or postoperative allogeneic transfusions. Estimated blood loss, levels fused, volume(s) transfused, and all related complications were recorded. Costs included the cost of allogeneic blood transfusion, setting up the cell saver recovery system, and infusing autologous blood from cell saver, whereas effectiveness measures were allogeneic blood transfusions averted and quality adjusted life years.
  
  
  RESULTS
  The incremental cost-effectiveness ratio was $55,538 per allogeneic transfusion averted, with a decrease in the transfusion rate from 40.0% to 38.7% associated with the cell saver approach. This translated into an incremental cost-effectiveness ratio of $5,555,380 per quality adjusted life years gained, which is well above the threshold for an intervention to be considered cost-effective ($100,000 per quality adjusted life years gained).
  
  
  CONCLUSIONS
  The use of cell saver during a single-level PLDF does not significantly reduce the need for allogeneic blood transfusion and is not cost-effective. The high cost of cell saver in combination with the low complication rate of allogeneic blood transfusion, suggest that cell saver should not be used for single-level PLDF. Further studies are needed to evaluate the necessity for cell saver among other types of spinal surgery.
authors.affiliation: Norton Leatherman Spine Center, Louisville, KY 40202, USA.
authors.forename: Chelsea E
authors.initials: CE
authors.lastname: Canan
authors.forename: John A
authors.initials: JA
authors.lastname: Myers
authors.forename: Roger Kirk
authors.initials: RK
authors.lastname: Owens
authors.forename: Charles H
authors.initials: CH
authors.lastname: Crawford
authors.forename: Mladen
authors.initials: M
authors.lastname: Djurasovic
authors.forename: Lauren O
authors.initials: LO
authors.lastname: Burke
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Bratcher
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: McCarthy
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000191:economics / Q000379:methods; D001804:Blood Transfusion, Autologous / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods; D011182:Postoperative Care; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics / Q000379:methods; D014184:Transplantation, Homologous / Q000191:economics / Q000379:methods; D055815:Young Adult