title: Utility of cell salvage in women undergoing abdominal myomectomy.
abstract: OBJECTIVE
  We examined the use and cost of autologous blood cell salvage in women who undergo abdominal myomectomy.
  
  
  METHODS
  Patients who underwent abdominal myomectomy from 2007-2011 were identified. Use of the cell salvage system and reinfusion of autologous blood in women who had the system set-up were analyzed. Cost was examined by directly reported data.
  
  
  RESULTS
  We identified 607 patients who underwent abdominal myomectomy. Four hundred twenty-five women (70%) had the set-up of the cell salvage system. Cell-salvaged blood was processed and reinfused into 85 of these subjects (20%). In a multivariable model, performance of myomectomy by a gynecologic-specific surgeon (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.28-3.59), >5 myomas (OR, 2.49; 95% CI, 1.27-4.89), and larger uterine size statistically were associated significantly with cell-salvage device set-up. Conversely, having a reproductive-endocrinology-infertility specialist as the surgeon was associated with a significant reduction in cell-salvage system set-up (OR, 0.37; 95% CI, 0.21-0.66). For the women who had cell-salvage system set-up, uterine size of >15-19 weeks of gestation (OR, 3.22; 95% CI, 1.56-8.95) or ≥20 weeks of gestation (OR, 4.62; 95% CI, 1.45-14.73), operating time of >120 minutes (OR, 3.98; 95% CI, 1.70-9.29), and intraoperative blood loss of >1000 mL (OR, 26.31; 95% CI, 10.49-65.99) were associated significantly with a higher incidence of reinfusion of cell-salvaged blood.
  
  
  CONCLUSIONS
  The routine use of cell salvage in women who undergo abdominal myomectomy does not appear to be warranted. Cell-salvage set-up appears to be cost-effective only when reinfused, but clinical characteristics cannot predict accurately which women will require reinfusion of cell-salvaged blood.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia University, New York, NY.
authors.forename: Moeun
authors.initials: M
authors.lastname: Son
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia University, New York, NY.
authors.forename: John C
authors.initials: JC
authors.lastname: Evanko
authors.affiliation: Department of Clinical Perfusion, New York Presbyterian Hospital, Columbia University Medical Center, Columbia University, New York, NY.
authors.forename: Linda B
authors.initials: LB
authors.lastname: Mongero
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Medical Center, Columbia University, New York, NY.
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia University, New York, NY.
authors.forename: Yu-Shiang
authors.initials: YS
authors.lastname: Lu
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Medical Center, Columbia University, New York, NY.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia University, New York, NY.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University Medical Center, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Medical Center, Columbia University, New York, NY. Electronic address: jw2459@columbia.edu.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D000328:Adult; D001804:Blood Transfusion, Autologous / Q000191:economics / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D016015:Logistic Models; D015999:Multivariate Analysis; D009519:New York City; D057725:Operative Blood Salvage / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: blood; cell saver; transfusion