title: Intra-operative cell salvage in cardiac surgery may increase platelet transfusion requirements: a cohort study.
abstract: OBJECTIVE
  The cell saver (CS) has been widely utilized in cardiac surgery to reduce red blood cell (RBC) transfusion. We aim at examining its effect on the rate of allogeneic transfusion, morbidity and mortality in our population.
  
  
  METHODS
  Retrospective review of all patients operated at the Sultan Qaboos University Hospital between 2008 and 2013 was performed. Patients' demographics, comorbidities and surgical details were retrieved. Study end-points included blood transfusion, infection, renal failure and mortality. Baseline characteristics of both groups were compared and differences were adjusted for in the multivariable logistic regression.
  
  
  RESULTS
  A total of 673 patients were included (CS = 395, non-CS = 278). Baseline characteristics were similar except for systemic hypertension, congestive heart failure and use of cardiopulmonary bypass. The CS group had higher transfusion rates of platelets (CS 36% vs. non-CS 18%; P < 0·001) and plasma (CS 31% vs. non-CS 19%; P < 0·001). After adjusting for baseline differences, CS use increased the odds of receiving platelet transfusion (odds ratio (OR) 3·2; P < 0·001) but not of plasma transfusion (OR 1·6; P = 0·087). There was no difference in the rate of RBC transfusion (CS 45% vs. non-CS 40%; P = 0·212), renal failure (CS 11% vs. non-CS 6%; P = 0·139), infection (CS 16% vs. non-CS 13%; P = 0·434) and mortality (CS 5% vs. non-CS 2%; P = 0·146).
  
  
  CONCLUSIONS
  The CS use increases platelet requirements and has no impact on the rate of RBC transfusion in our population. These findings warrant caution with generalized use and require larger studies to confirm its results.
authors.affiliation: Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: A Z
authors.initials: AZ
authors.lastname: Al-Riyami
authors.affiliation: Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-2937-8838
authors.initials: M
authors.lastname: Al-Khabori
authors.affiliation: Department of Surgery, Cardiothoracic Surgery Division, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: B
authors.initials: B
authors.lastname: Baskaran
authors.affiliation: Department of Surgery, Cardiothoracic Surgery Division, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: M
authors.initials: M
authors.lastname: Siddiqi
authors.affiliation: Department of Surgery, Cardiothoracic Surgery Division, Sultan Qaboos University Hospital, Muscat, Oman.
authors.forename: H
authors.initials: H
authors.lastname: Al-Sabti
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D003710:Demography; D017707:Erythrocyte Transfusion; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017713:Platelet Transfusion; D012189:Retrospective Studies
keywords: platelet transfusion; transfusion strategy; transfusion-surgery