The cell saver in adult lumbar fusion surgery: A cost-benefit outcomes study

Study Design. Review of efficacy of Cell Saver in a non-randomized group of patients undergoing lumbar fusion. Objectives. Determine the necessity and cost-effectiveness of the use of Cell Saver for adult lumbar spine fusions. Summary of Background Data. Specific indications for the use of Cell Saver in adult lumbar fusion surgery have not been clearly determined. In addition to effectiveness in blood replacement, the economic benefits of the Cell Saver have not been evaluated. Methods. A total of 102 consecutive cases of posterolateral fusion with internal fixation were reviewed retrospectively. There were 56 patients in the Cell Saver group and 46 patients in the control group. Recorded hospital medical and financial data were analyzed for each patient. Results. There was a 38% recovery rate of blood using the Cell Saver. This resulted in a decreased need for postoperative transfusion in the study group (1 U to 36% of patients) relative to the control group (1 U to 50% of patients). Significant predictors for surgery time were the number of levels fused (P < 0.0001), patient's weight (P = 0.0030), and use of Cell Saver (P = 0.0472). Significant indicators of blood loss were the number of levels fused (P < 0.0001) and surgical time (P = 0.0304). The average cost for blood-related charges in the Cell Saver group was $512 versus $270 per patient in the control group. Conclusions. While the Cell Saver group did require fewer postoperative transfusions, the difference was not as much as expected. In elective fusions for degenerative conditions of the lumbar spine, blood requirements can usually be satisfied with predonation of autologous blood. With contemporary practices of predonation, the use of the Cell Saver appears to be neither necessary nor cost-effective during most elective lumbar fusions.