title: Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study.
abstract: BACKGROUND
  A relatively new method of electrocautery, the radiofrequency bipolar hemostatic sealer (RBHS), uses saline-cooled delivery of energy, which seals blood vessels rather than burning them. We assessed the benefits of RBHS as a blood conservation strategy in adult patients undergoing multilevel spinal fusion surgery.
  
  
  METHODS
  In a retrospective cohort study, we compared blood utilization in 36 patients undergoing multilevel spinal fusion surgery with RBHS (Aquamantys, Medtronic, Minneapolis, MN, USA) to that of a historical control group (n = 38) matched for variables related to blood loss. Transfusion-related costs were calculated by two methods.
  
  
  RESULTS
  Patient characteristics in the two groups were similar. Intraoperatively, blood loss was 55% less in the RBHS group than in the control group (810 ± 530 vs. 1,800 ± 1,600 mL; p = 0.002), and over the entire hospital stay, red cell utilization was 51% less (2.4 ± 3.4 vs. 4.9 ± 4.5 units/patient; p = 0.01) and plasma use was 56% less (1.1 ± 2.4 vs. 2.5 ± 3.4 units/patient; p = 0.03) in the RBHS group. Platelet use was 0.1 ± 0.5 and 0.3 ± 0.6 units/patient in the RBHS and control groups, respectively (p = 0.07). The perioperative decrease in hemoglobin was less in the RBHS group than in the control group (-2.0 ± 2.2 vs. -3.2 ± 2.1 g/dL; p = 0.04), and hemoglobin at discharge was higher in the RBHS group (10.5 ± 1.4 vs. 9.7 ± 0.9 g/dL; p = 0.01). The estimated transfusion-related cost savings were $745/case by acquisition cost and approximately 3- to 5-fold this amount by activity-based cost.
  
  
  CONCLUSIONS
  The use of RBHS in patients undergoing multilevel spine fusion surgery can conserve blood, promote higher hemoglobin levels, and reduce transfusion-related costs.
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore 21287, MD, USA. sfrank3@jhmi.edu.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Frank
authors.forename: Jack O
authors.initials: JO
authors.lastname: Wasey
authors.forename: Ian M
authors.initials: IM
authors.lastname: Dwyer
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D057668:Bloodless Medical and Surgical Procedures / Q000379:methods*; D016022:Case-Control Studies; D017046:Cost Savings; D004564:Electrocoagulation / Q000191:economics / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000191:economics / Q000295:instrumentation
chemical_list: D006454:Hemoglobins