Efficacy and cost-effectiveness of the cell saver system in instrumented posterior fusion with thoracic and lumbar vertebral fractures

BACKGROUND: The aim of our study was to determine the efficacy and cost-effectiveness of intraoperative autotransfusion that uses the cell saver system (CSS) in patients undergoing posterior instrumentation and fusion of thoracic and lumbar vertebral fractures.
METHODS: We divided 121 patients who were to undergo posterior instrumentation and fusion due to thoracic and lumbar vertebral fractures into two groups: 59 patients (23 males and 36 females) were in the cell saver group, and 62 patients (22 males and 40 females) were in the control group. Hemoglobin, hematocrit, and red blood cell (RBC) values were recorded for all patients preoperatively, on the postoperative first, second, and third days, and on the hospital discharge day. Transfusion rates and numbers of allogeneic erythrocyte transfusions, as well as the costs of transfused total auto- and allogeneic transfusions were compared.
RESULTS: The numbers of erythrocyte suspensions transfused perioperatively were 0.2±0.6 units in the cell saver group and 0.7±1.4 units in the control group (p=0.01). Statistically significant differences were noted between the two groups on the postoperative first, second, and third days in terms of hemoglobin, hematocrit, and RBC values. These differences had disappeared by the hospital discharge day. The average cost of perioperative blood transfusions was $431±27.4 in the cell saver group and $34.5±66.25 in the control group (p<0.001).
CONCLUSION: The use of the CSS was not cost-effective, but it was particularly successful at reducing the rate and the number of units of postoperative allogenic blood transfusions.

Torakal ve lomber vertebra kýrýklarýnda enstrümentasyon ve posterior füzyon uygulanmýþ hastalarda maliyet ve hücre koruyucu sistemin etkinliði

AMAÇ: Çalýþmamýzýn amacý torakal ve lomber vertebra kýrýklarý nedeniyle posterior enstrümantasyon ve füzyon yapýlan ve ameliyatta ototransfüzyon yapýlan hastalarda hücre koruyucu sistemin etkinliðini ve maliyet etkinliðini belirlemektir.
GEREÇ VE YÖNTEM: Torakal ve lomber vertebra kýrýklarý nedeniyle posteriyor enstrümentasyon ve füzyon uygulanmýþ 121 hasta iki guruba ayrýldý: 59 hasta (23 erkek ve 36 kadýn) hücre koruyucu gurup, 62 hasta (22 erkek ve 40 kadýn) kontrol gurubuna dahil edildi. Hastalarýn hemoglobin, hemotokrit ve kýrmýzý hücre sayýsý (KHS) ameliyat öncesi ve sonrasý birinci, ikinci, üçüncü gün ve taburculuk esnasýndaki deðerleri deðerlendirildi. Transfüzyon oranlarý ve allojenik eritrosit transfüzyonlarýnýn (AET’ler) yaný sýra, transfüzyona tabi tutulan toplam oto ve allojenik transfüzyonlarýn maliyetleri karþýlaþtýrýldý.
BULGULAR: Perioperatif kan transfüzyonu hücre koruyucu grupta 0.2±0.6 ünite, kontrol grubunda 0.7±1.4 ünite olarak tespit edildi (p=0.01). Ameliyat sonrasý birinci, ikinci ve üçüncü günde hemoglobin, hemotokrit ve KHS arasýnda istatistiksel olarak anlamlý fark tespit edildi. Taburculuk hemoglobin, hemotokrit ve KHS arasýnda anlamlý farklýlýk saptanmadý. Perioperatif kan transfüzyonu ortalama maliyeti hücre koruyucu grupta $431±27.4, kontrol grubunda $34.5±66.25 olarak belirlendi (p<0.001).
TARTIÞMA: Hücre koruma sisteminin kullanýmý maliyet açýsýndan uygun deðildi, ancak özellikle ameliyat sonrasý allojenik kan transfüzyonlarýnýn oranýný ve sayýsýný azaltmada baþarýlýydý.