The Efficacy and Cost-Effectiveness of Cell Saver Use in Instrumented Posterior Correction and Fusion Surgery for Scoliosis in School-Aged Children and Adolescents

Posterior spinal instrumentation and fusion surgery in school-aged children and adolescents is associated with the potential for massive intraoperative blood loss, which requires significant allogeneic blood transfusion. Until now, the intraoperative use of the cell saver has been extensively adopte...

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Published in:	PloS one Vol. 9; no. 4; p. e92997
Main Authors:	Miao, Yu-Liang, Ma, Hua-Song, Guo, Wen-Zhi, Wu, Ji-Gong, Liu, Yan, Shi, Wen-Zhu, Wang, Xiao-Ping, Mi, Wei-Dong, Fang, Wei-Wu
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 01.04.2014 Public Library of Science (PLoS)
Subjects:	Adolescent Adolescents Age Analysis Anesthesiology Bacterial infections Blood Blood transfusion Blood transfusions Care and treatment Child Children Cohort Studies Cost analysis Cost engineering Cost-Benefit Analysis Demography Diagnosis Economic aspects Effectiveness Erythrocyte Transfusion - economics Erythrocytes Hospitals Humans Instrumentation Instruments Joint surgery Medical care, Cost of Medical malpractice Medical records Medicine and Health Sciences Patients Pediatrics Perioperative Care Propensity Score Risk factors Schools Scoliosis Scoliosis - economics Scoliosis - surgery Spinal Fusion - economics Surgery Teenagers Transfusion Treatment Outcome Beijing China China
ISSN:	1932-6203, 1932-6203
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Abstract	Posterior spinal instrumentation and fusion surgery in school-aged children and adolescents is associated with the potential for massive intraoperative blood loss, which requires significant allogeneic blood transfusion. Until now, the intraoperative use of the cell saver has been extensively adopted; however, its efficacy and cost-effectiveness have not been well established. Therefore, the aim of this study is to determine the efficacy and cost-effectiveness of intraoperative cell saver use. This study was a single-center, retrospective study of 247 school-aged and adolescent patients who underwent posterior spinal instrumentation and fusion surgery between August 2007 and June 2013. A cell saver was used intraoperatively in 67 patients and was not used in 180 patients. Matched case-control pairs were selected using a propensity score to balance potential confounders in baseline characteristics. Allogeneic red blood cell (RBC) and plasma transfusions as well as blood transfusion costs were analyzed. The propensity score matching produced 60 matched pairs. Compared to the control group, the cell saver group had significantly fewer intraoperative allogeneic RBC transfusions (P = 0.012). However, when the combined postoperative and total perioperative periods were evaluated for the use of allogeneic RBC transfusion, no significant differences were observed between the two groups (P = 0.813 and P = 0.101, respectively). With regard to the total cost of perioperative transfusion of all blood products (RBC and plasma), costs for the control group were slightly lower than those of the cell saver group, but this variance did not reach statistical significance (P = 0.095). The use of the cell saver in posterior spinal instrumentation and fusion surgery in school-aged children and adolescents was able to decrease the amount of intraoperative allogeneic RBC transfusion but failed to decrease total perioperative allogeneic RBC transfusion. Moreover, the use of the cell saver was not cost-effective.
AbstractList	Posterior spinal instrumentation and fusion surgery in school-aged children and adolescents is associated with the potential for massive intraoperative blood loss, which requires significant allogeneic blood transfusion. Until now, the intraoperative use of the cell saver has been extensively adopted; however, its efficacy and cost-effectiveness have not been well established. Therefore, the aim of this study is to determine the efficacy and cost-effectiveness of intraoperative cell saver use. This study was a single-center, retrospective study of 247 school-aged and adolescent patients who underwent posterior spinal instrumentation and fusion surgery between August 2007 and June 2013. A cell saver was used intraoperatively in 67 patients and was not used in 180 patients. Matched case-control pairs were selected using a propensity score to balance potential confounders in baseline characteristics. Allogeneic red blood cell (RBC) and plasma transfusions as well as blood transfusion costs were analyzed. The propensity score matching produced 60 matched pairs. Posterior spinal instrumentation and fusion surgery in school-aged children and adolescents is associated with the potential for massive intraoperative blood loss, which requires significant allogeneic blood transfusion. Until now, the intraoperative use of the cell saver has been extensively adopted; however, its efficacy and cost-effectiveness have not been well established. Therefore, the aim of this study is to determine the efficacy and cost-effectiveness of intraoperative cell saver use. This study was a single-center, retrospective study of 247 school-aged and adolescent patients who underwent posterior spinal instrumentation and fusion surgery between August 2007 and June 2013. A cell saver was used intraoperatively in 67 patients and was not used in 180 patients. Matched case-control pairs were selected using a propensity score to balance potential confounders in baseline characteristics. Allogeneic red blood cell (RBC) and plasma transfusions as well as blood transfusion costs were analyzed. The propensity score matching produced 60 matched pairs. Compared to the control group, the cell saver group had significantly fewer intraoperative allogeneic RBC transfusions (P = 0.012). However, when the combined postoperative and total perioperative periods were evaluated for the use of allogeneic RBC transfusion, no significant differences were observed between the two groups (P = 0.813 and P = 0.101, respectively). With regard to the total cost of perioperative transfusion of all blood products (RBC and plasma), costs for the control group were slightly lower than those of the cell saver group, but this variance did not reach statistical significance (P = 0.095). The use of the cell saver in posterior spinal instrumentation and fusion surgery in school-aged children and adolescents was able to decrease the amount of intraoperative allogeneic RBC transfusion but failed to decrease total perioperative allogeneic RBC transfusion. Moreover, the use of the cell saver was not cost-effective. Posterior spinal instrumentation and fusion surgery in school-aged children and adolescents is associated with the potential for massive intraoperative blood loss, which requires significant allogeneic blood transfusion. Until now, the intraoperative use of the cell saver has been extensively adopted; however, its efficacy and cost-effectiveness have not been well established. Therefore, the aim of this study is to determine the efficacy and cost-effectiveness of intraoperative cell saver use. This study was a single-center, retrospective study of 247 school-aged and adolescent patients who underwent posterior spinal instrumentation and fusion surgery between August 2007 and June 2013. A cell saver was used intraoperatively in 67 patients and was not used in 180 patients. Matched case-control pairs were selected using a propensity score to balance potential confounders in baseline characteristics. Allogeneic red blood cell (RBC) and plasma transfusions as well as blood transfusion costs were analyzed. The propensity score matching produced 60 matched pairs. Compared to the control group, the cell saver group had significantly fewer intraoperative allogeneic RBC transfusions (P = 0.012). However, when the combined postoperative and total perioperative periods were evaluated for the use of allogeneic RBC transfusion, no significant differences were observed between the two groups (P = 0.813 and P = 0.101, respectively). With regard to the total cost of perioperative transfusion of all blood products (RBC and plasma), costs for the control group were slightly lower than those of the cell saver group, but this variance did not reach statistical significance (P = 0.095). The use of the cell saver in posterior spinal instrumentation and fusion surgery in school-aged children and adolescents was able to decrease the amount of intraoperative allogeneic RBC transfusion but failed to decrease total perioperative allogeneic RBC transfusion. Moreover, the use of the cell saver was not cost-effective.Posterior spinal instrumentation and fusion surgery in school-aged children and adolescents is associated with the potential for massive intraoperative blood loss, which requires significant allogeneic blood transfusion. Until now, the intraoperative use of the cell saver has been extensively adopted; however, its efficacy and cost-effectiveness have not been well established. Therefore, the aim of this study is to determine the efficacy and cost-effectiveness of intraoperative cell saver use. This study was a single-center, retrospective study of 247 school-aged and adolescent patients who underwent posterior spinal instrumentation and fusion surgery between August 2007 and June 2013. A cell saver was used intraoperatively in 67 patients and was not used in 180 patients. Matched case-control pairs were selected using a propensity score to balance potential confounders in baseline characteristics. Allogeneic red blood cell (RBC) and plasma transfusions as well as blood transfusion costs were analyzed. The propensity score matching produced 60 matched pairs. Compared to the control group, the cell saver group had significantly fewer intraoperative allogeneic RBC transfusions (P = 0.012). However, when the combined postoperative and total perioperative periods were evaluated for the use of allogeneic RBC transfusion, no significant differences were observed between the two groups (P = 0.813 and P = 0.101, respectively). With regard to the total cost of perioperative transfusion of all blood products (RBC and plasma), costs for the control group were slightly lower than those of the cell saver group, but this variance did not reach statistical significance (P = 0.095). The use of the cell saver in posterior spinal instrumentation and fusion surgery in school-aged children and adolescents was able to decrease the amount of intraoperative allogeneic RBC transfusion but failed to decrease total perioperative allogeneic RBC transfusion. Moreover, the use of the cell saver was not cost-effective.
Audience	Academic
Author	Liu, Yan Wu, Ji-Gong Shi, Wen-Zhu Mi, Wei-Dong Fang, Wei-Wu Wang, Xiao-Ping Miao, Yu-Liang Ma, Hua-Song Guo, Wen-Zhi
AuthorAffiliation	1 Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, P.R. China German Red Cross Blood Service Frankfurt, Germany 2 Department of Anesthesiology, Chinese PLA No. 306 Hospital, Beijing, P.R. China 3 Department of Orthopaedics and Spine Surgery, Chinese PLA No. 306 Hospital, Beijing, P.R. China 4 Department of Anesthesiology, Beijing Military General Hospital of the PLA, Beijing, P.R. China
AuthorAffiliation_xml	– name: German Red Cross Blood Service Frankfurt, Germany – name: 3 Department of Orthopaedics and Spine Surgery, Chinese PLA No. 306 Hospital, Beijing, P.R. China – name: 1 Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, P.R. China – name: 4 Department of Anesthesiology, Beijing Military General Hospital of the PLA, Beijing, P.R. China – name: 2 Department of Anesthesiology, Chinese PLA No. 306 Hospital, Beijing, P.R. China
Author_xml	– sequence: 1 givenname: Yu-Liang surname: Miao fullname: Miao, Yu-Liang – sequence: 2 givenname: Hua-Song surname: Ma fullname: Ma, Hua-Song – sequence: 3 givenname: Wen-Zhi surname: Guo fullname: Guo, Wen-Zhi – sequence: 4 givenname: Ji-Gong surname: Wu fullname: Wu, Ji-Gong – sequence: 5 givenname: Yan surname: Liu fullname: Liu, Yan – sequence: 6 givenname: Wen-Zhu surname: Shi fullname: Shi, Wen-Zhu – sequence: 7 givenname: Xiao-Ping surname: Wang fullname: Wang, Xiao-Ping – sequence: 8 givenname: Wei-Dong surname: Mi fullname: Mi, Wei-Dong – sequence: 9 givenname: Wei-Wu surname: Fang fullname: Fang, Wei-Wu
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/24691056$$D View this record in MEDLINE/PubMed
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Conceived and designed the experiments: YLM WWF YL HSM JGW. Performed the experiments: YLM WWF WZG WZS YL. Analyzed the data: YLM WWF YL XPW WDM. Contributed reagents/materials/analysis tools: YLM WWF YL. Wrote the paper: YLM YL WDM WWF. Competing Interests: The authors have declared that no competing interests exist.
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References_xml	– ident: ref1 – volume: 50 start-page: 753 year: 2010 ident: ref20 article-title: Activity-based costs of blood transfusions in surgical patients at four hospitals publication-title: Transfusion doi: 10.1111/j.1537-2995.2009.02518.x – volume: 33 start-page: 2310 year: 2008 ident: ref19 article-title: Blood conservation techniques in spinal deformity surgery: a retrospective review of patients refusing blood transfusion publication-title: Spine (Phila Pa 1976) doi: 10.1097/BRS.0b013e31818047f2 – volume: 96 start-page: 107 year: 2012 ident: ref6 article-title: Posterior spinal fusion in adolescent idiopathic scoliosis with or without intraoperative cell salvage system: a retrospective comparison publication-title: Musculoskelet Surg doi: 10.1007/s12306-012-0203-6 – volume: 35 start-page: 246 year: 2010 ident: ref5 article-title: Efficacy of intraoperative cell salvage systems in pediatric idiopathic scoliosis patients undergoing posterior spinal fusion with segmental spinal instrumentation publication-title: Spine (Phila Pa 1976) doi: 10.1097/BRS.0b013e3181bdf22a – volume: 35 start-page: S47 year: 2010 ident: ref10 article-title: Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion surgery publication-title: Spine (Phila Pa 1976) doi: 10.1097/BRS.0b013e3181d833f6 – volume: 29 start-page: 1580 year: 2004 ident: ref15 article-title: The Cell Saver in adult lumbar fusion surgery: a cost-benefit outcomes study publication-title: Spine (Phila Pa 1976) doi: 10.1097/01.BRS.0000131433.05946.4F – volume: 1 start-page: 221 year: 2007 ident: ref11 article-title: Cell Saver: is it beneficial in scoliosis surgery publication-title: J Child Orthop doi: 10.1007/s11832-007-0032-6 – volume: 27 start-page: 2037 year: 2008 ident: ref13 article-title: A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003 publication-title: Stat Med doi: 10.1002/sim.3150 – volume: 33 start-page: 571 year: 2008 ident: ref18 article-title: Efficacy of intraoperative cell saver in decreasing postoperative blood transfusions in instrumented posterior lumbar fusion patients publication-title: Spine (Phila Pa 1976) doi: 10.1097/BRS.0b013e3181657cc1 – volume: 21 start-page: 14 year: 2011 ident: ref14 article-title: Blood transfusion risks and alternative strategies in pediatric patients publication-title: Paediatr Anaesth doi: 10.1111/j.1460-9592.2010.03470.x – volume: 38 start-page: 703 year: 2013 ident: ref9 article-title: Blood salvage produces higher total blood product costs in single-level lumbar spine surgery publication-title: Spine (Phila Pa 1976) doi: 10.1097/BRS.0b013e3182767c8c – volume: 19 start-page: 202 year: 2009 ident: ref16 article-title: Efficacy and cost-effectiveness of cell saving blood autotransfusion in adult lumbar fusion publication-title: Transfus Med doi: 10.1111/j.1365-3148.2009.00929.x – volume: 96 start-page: 298 year: 2002 ident: ref3 article-title: Autotransfusion by cell saver technique in surgery of lumbar and thoracic spinal fusion with instrumentation publication-title: J Neurosurg – volume: 38 start-page: 350 year: 2013 ident: ref2 article-title: Prediction of massive blood loss in scoliosis surgery from preoperative variables publication-title: Spine (Phila Pa 1976) doi: 10.1097/BRS.0b013e31826c63cb – volume: 54 start-page: 908 year: 2003 ident: ref4 article-title: Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis publication-title: J Trauma doi: 10.1097/01.TA.0000022460.21283.53 – volume: 38 start-page: E217 year: 2013 ident: ref8 article-title: Predictive factors for the use of autologous cell saver transfusion in lumbar spinal surgery publication-title: Spine (Phila Pa 1976) doi: 10.1097/BRS.0b013e31827f044e – volume: 17 start-page: 4161 year: 2013 ident: ref17 article-title: Movement intervention recovers the Cobb angle of adolescent idiopathic scoliosis publication-title: Chinese Journal of Tissue Engineering Research – volume: 14; (4) start-page: CD001888 year: 2010 ident: ref7 article-title: Cell salvage for minimising perioperative allogeneic blood transfusion publication-title: Cochrane Database Syst Rev Apr – ident: ref12
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SubjectTerms	Adolescent Adolescents Age Analysis Anesthesiology Bacterial infections Blood Blood transfusion Blood transfusions Care and treatment Child Children Cohort Studies Cost analysis Cost engineering Cost-Benefit Analysis Demography Diagnosis Economic aspects Effectiveness Erythrocyte Transfusion - economics Erythrocytes Hospitals Humans Instrumentation Instruments Joint surgery Medical care, Cost of Medical malpractice Medical records Medicine and Health Sciences Patients Pediatrics Perioperative Care Propensity Score Risk factors Schools Scoliosis Scoliosis - economics Scoliosis - surgery Spinal Fusion - economics Surgery Teenagers Transfusion Treatment Outcome
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Title	The Efficacy and Cost-Effectiveness of Cell Saver Use in Instrumented Posterior Correction and Fusion Surgery for Scoliosis in School-Aged Children and Adolescents
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