title: Predictive factors for the use of autologous cell saver transfusion in lumbar spinal surgery.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  To identify risk factors for cell saver transfusion in lumbar spinal surgery and determine if cell saver transfusions affected intraoperative or postoperative transfusion rates.
  
  
  BACKGROUND
  Cell saver has been used to minimize allogeneic blood transfusion in lumbar spinal surgery. Conflicting reports exist, which call into question the efficacy of cell saver use.
  
  
  METHODS
  We reviewed medical records of randomly selected patients who underwent posterolateral fusion with or without transforaminal interbody fusion from July 2010 to June 2011. Transfusion rates and transfusion-related complications were determined. Binary logistic regression was performed to identify risk factors for use of autologous cell saver transfusion.
  
  
  RESULTS
  There were 178 females and 107 males, with a mean age of 57.2 years. Of the 285 cases, 39 had no cell saver available, 147 had cell saver available but no autologous blood was recovered or transfused and 99 had an autologous cell saver transfusion. Patients who had cell saver transfusion had a higher rate of intraoperative allogeneic blood transfusion (52%) compared with those who did not (22%). There was no significant difference in the rate of postoperative transfusions or transfusion-related reactions between patients who did and did not have cell saver transfusion. Patient's age, smoking status, American Society of Anesthesiologists grade, use of anticoagulants preoperatively, primary or revision surgery, iliac crest bone graft harvest, anesthesiologist, or surgeon had no significant effect on cell saver infusion. Body mass index (odds ratio [OR] = 1.06), number of posterolateral fusion levels fused (OR = 2.50), and number of transforaminal interbody fusions performed (OR = 2.41) were independent risk factors for the use of autologous cell saver transfusion.
  
  
  CONCLUSIONS
  Body mass index, multi-level fusion and transforaminal interbody fusion result in increased use of autologous cell saver transfusion in lumbar spinal surgery. Use of autologous cell saver transfusion did not reduce the requirement for intraoperative or postoperative allogeneic blood transfusion.
  
  
  METHODS
  2.
authors.affiliation: Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA.
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: Chelsea E
authors.initials: CE
authors.lastname: Canan
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 Yacat
authors.initials: LY
authors.lastname: Carreon
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D015992:Body Mass Index; D005260:Female; D006801:Humans; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057725:Operative Blood Salvage / Q000009:adverse effects / Q000295:instrumentation*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects; D016896:Treatment Outcome