Intraoperative red blood cell salvage in posterior spinal fusions for idiopathic scoliosis: identifying potential criteria for selective use

Study design: Retrospective. Objectives: Evaluate the role and effectiveness of ICS in primary posterior spinal fusion (PSF) for idiopathic scoliosis (IS). Summary of background data: Intraoperative cell salvage (ICS) minimizes blood loss and need for allogeneic transfusions. However, it adds substantial charges ($800–1200 US) and may be of less clinical benefit in some PSF for IS. Materials and methods: This was a single-hospital, retrospective analysis of 178 consecutive IS cases (10–18 years of age) who underwent primary PSF by a single pediatric spine surgeon. Results: Overall, 41% of cases received a mean 167 cc of ICS blood, after a mean EBL of 528 mL (range 200–1800 mL). No blood was returned in 59% of cases, with a mean EBL of 293 mL (range 75–700 mL). Only 6.5% of the entire cohort received > / = 250 cc via ICS, after a mean EBL of 773 mL. A positive correlation exists between EBL and vertebral levels fused, preoperative major Cobb angle, and length of anesthesia (p < 0.001). ICS may be more efficacious at an inflection point of 12 vertebral fusion levels, preoperative major Cobb angles > / = 55°, anesthesia exposure > / = 6 h, and with use of posterior column osteotomies (PCOs) (p < 0.05). In addition, lack of tranexamic acid use lead to greater EBL (p < 0.0001) and ICS volumes (p = 0.008). Conclusion: The use of ICS in IS patients undergoing PSF resulted in the return of > / = 250 cc of ICS blood (similar volume to one allogeneic unit) in only 6.5% of cases. Charges for ICS set-up and processing of one bowl of ICS is much higher than for one allogeneic unit ($1200 vs. $462 US), hence transfusing lower volumes of autologous ICS blood is not cost-effective for all PSF for IS. Level of evidence: IV; Therapeutic studies.