Postoperative Blood Salvage and Autotransfusion for Adult Spinal Deformity: A Randomized Controlled Trial.
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2020;8(21):19 Spine (Phila Pa 1976). 2020 Sep 15;45(18):1247-1252.What this means for my practice?
Study findings suggest that whilst hemoglobin levels in the first 3 days post-operation are significantly higher in the blood salvaging group, the amount of blood transfusion is similar compared to the closed suction drainage group. The need for nursing staff to reinfused the blood manually may have affected the amount of reinfused blood in the blood salvage group, and an automated reinfusion system is of interest. Furthermore, the use of anti-fibrinolytics likely reduced the amount of blood loss, which in turn reduced the utility of blood salvaging and reinfusion. Moreover, future studies investigating other blood collection systems are of interest.
Study Summary
Sixty-five patients with spinal deformity scheduled for a lumbar spinal fusion surgery were randomized to receive a blood salvaging and re-infusion system or traditional closed suction drainage for the reduction of homologous blood transfusion. The primary outcome of interest was post-operative homologous blood transfusion volume. Additional outcomes of interest included estimated blood loss, IV fluid volume, autologous blood transfusion, drainage output, and hemoglobin levels. Outcomes were assessed both intra-operatively and post-operatively. No statistically significantly differences in homologous blood transfusion volume, both intra-operatively and post-operatively, were observed between the two groups (p=0.48, p=0.35). Drainage output at 24 hours and total drainage output were statistically significantly higher in the blood salvaging group compared to the closed suction drainage group (p=0.0005; p=0.005). Hemoglobin levels at post-operative day 2 and 3 were significantly higher in the blood salvaging group (p=0.02, p=0.01). No statistically significant differences were observed between groups in the remaining outcomes.
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