title: Does intraoperative cell salvage system effectively decrease the need for allogeneic transfusions in scoliotic patients undergoing posterior spinal fusion? A prospective randomized study.
abstract: OBJECTIVE
  To determine the safety and efficacy of intraoperative cell salvage system in decreasing the need for allogeneic transfusions in a cohort of scoliosis patients undergoing primary posterior spinal fusion with segmental spinal instrumentation.
  
  
  METHODS
  A total of 110 consecutive scoliosis patients undergoing posterior instrumented spinal fusion were randomized into two groups according to whether a cell saver machine for intraoperative blood salvage was used or not. Data included age, body mass index, perioperative hemoglobin levels, surgical time, levels fused, perioperative estimated blood loss, perioperative transfusions and incidence of transfusion-related complications. A Chi-square test and t tests were performed for intraoperative and perioperative allogeneic transfusion between groups. A regression analysis was performed between selected covariates to investigate the predictive factors of perioperative transfusion.
  
  
  RESULTS
  Perioperative allogenic blood transfusion rate was lower in the cell saver group (14.5 versus 32.7%, p = 0.025). Mean intraoperative red blood cell transfusion requirement was also lower (0.21 U/pt versus 0.58 U/pt, p = 0.032). A multivariate analysis demonstrated that no. of fused segments (OR: 1.472; p = 0.005), preoperative hemoglobin level (OR: 0.901; p = 0.001), and the use of cell saver system (OR: 0.133; p = 0.003) had a trend toward significance in predicting likelihood of transfusion.
  
  
  CONCLUSIONS
  Cell saver use significantly reduces the need for allogeneic blood in spine deformity surgery, particularly in patients with low preoperative hemoglobin or longer operation time. This study confirms the utility of routine cell saver use during PSF with segmental spinal instrumentation for scoliosis patients.
authors.affiliation: Department of Orthopaedic Surgery, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China.
authors.forename: Jinqian
authors.initials: J
authors.lastname: Liang
authors.forename: Jianxiong
authors.initials: J
authors.lastname: Shen
authors.forename: Sooyong
authors.initials: S
authors.lastname: Chua
authors.forename: Yu
authors.initials: Y
authors.lastname: Fan
authors.forename: Jiliang
authors.initials: J
authors.lastname: Zhai
authors.forename: Bin
authors.initials: B
authors.lastname: Feng
authors.forename: Siyi
authors.initials: S
authors.lastname: Cai
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
authors.forename: Xuhong
authors.initials: X
authors.lastname: Xue
mesh_terms: D000293:Adolescent; D000368:Aged; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D057725:Operative Blood Salvage; D011446:Prospective Studies; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion; D055815:Young Adult