The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery.
Metastatic spine tumor surgery (MSTS) is associated with substantial blood loss, therefore leading to high morbidity and mortality. Although intraoperative cell salvage with leukocyte depletion filter (IOCS-LDF) has been studied as an effective means of reducing blood loss in other surgical settings, including the spine, no study has yet analyzed the efficacy of reinfusion of salvaged blood in reducing the need for allogenic blood transfusion in patients who have had surgery for MSTS.



This study aimed to analyze the efficacy, safety, and cost-effectiveness of using IOCS-LDF in MSTS.



This is a retrospective controlled study.



A total of 176 patients undergoing MSTS were included in the study.



All patients undergoing MSTS at a single center between February 2010 and December 2014 were included in the study. The primary outcome measure was the use of autologous blood transfusion. Secondary outcome measures included hospital stay, survival time, complications, and procedural costs. The key predictor variable was whether IOCS-LDF was used during surgery. Logistic and linear regression analyses were conducted by controlling variables such as tumor type, number of diseased vertebrae, approach, number and site of stabilized segments, operation time, preoperative anemia, American Society of Anesthesiologists (ASA) grade, age, gender, and body mass index (BMI). No funding was obtained and there are no conflicts of interest to be declared.



Data included 63 cases (IOCS-LDF) and 113 controls (non-IOCS-LDF). Intraoperative cell salvage with LDF utilization was substantively and significantly associated with a lower likelihood of allogenic blood transfusion (OR=0.407, p=.03). Intraoperative cell salvage with LDF was cost neutral (p=.88). Average hospital stay was 3.76 days shorter among IOCS-LDF patients (p=.03). Patient survival and complication rates were comparable in both groups.



We have demonstrated that the use of IOCS-LDF in MSTS reduces the need for postoperative allogenic blood transfusion while maintaining satisfactory postoperative hemoglobin. We recommend routine use of IOCS-LDF in MSTS for its safety, efficacy, and potential cost benefit.
Complex Spinal Unit, Salford Royal Foundation Trust (SRFT), Stott Ln, Salford, M6 8HD, Greater Manchester, United Kingdom. Electronic address: mah_elmalky@yahoo.com.
Mahmoud
M
Elmalky
Complex Spinal Unit, Salford Royal Foundation Trust (SRFT), Stott Ln, Salford, M6 8HD, Greater Manchester, United Kingdom.
Naveed
N
Yasin
Unidade Vertebro-Medular, Serviço de Ortopedia, Centro Hospitalar do Porto - Hospital de Santo António, Porto, Portugal.
Ricardo
R
Rodrigues-Pinto
School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, Great Britain.
John
J
Stephenson
Salford Royal Foundation Trust (SRFT), Stott Ln, Salford, M6 8HD, Greater Manchester, United Kingdom.
Craig
C
Carroll
Salford Royal Foundation Trust (SRFT), Stott Ln, Salford, M6 8HD, Greater Manchester, United Kingdom.
Glyn
G
Smurthwaite
Complex Spinal Unit, Salford Royal Foundation Trust (SRFT), Stott Ln, Salford, M6 8HD, Greater Manchester, United Kingdom.
Rajat
R
Verma
Complex Spinal Unit, Salford Royal Foundation Trust (SRFT), Stott Ln, Salford, M6 8HD, Greater Manchester, United Kingdom.
Saeed
S
Mohammad
Complex Spinal Unit, Salford Royal Foundation Trust (SRFT), Stott Ln, Salford, M6 8HD, Greater Manchester, United Kingdom.
Irfan
I
Siddique
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012044:Regression Analysis; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*
autologous transfusion; autotransfusion; blood loss in spinal metastatic surgeries; cell saver; intraoperative blood salvage autotransfusion; intraoperative cell salvage; leukocyte depletion filter; malignant tumor; tumor surgery