Indications and Outcomes of Cell Saver in Adolescent Scoliosis Correction Surgery
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STUDY DESIGN: Systematic review. OBJECTIVE: The aim of this study was to determine the indications and outcomes for intraoperative cell salvage during adolescent scoliosis correction surgery by systematically reviewing all available evidence. SUMMARY OF BACKGROUND DATA: Several blood conservation strategies exist to minimize the consequences of blood loss because of scoliosis correction surgery. The utility of intraoperative cell salvage has been contested in the literature with respect to benefits and cost. High-quality randomized control trials are needed to help surgeons make an informed decision about including Cell Saver into their practice. METHODS: The databases Medline, Embase, Ovid Healthstar, and PubMed were searched for English language literature investigating Cell Saver use during adolescent scoliosis correction surgery, mean ages 10 to 19 years inclusively. Qualitative and quantitative findings from relevant studies are presented. RESULTS: There were seven eligible studies that directly compared the use of Cell Saver (349 patients) against a Control (non-Cell Saver) group (244 patients). The majority of the demographic and hematologic data were consistent between both groups. The average volume of blood that was re-infused into patients in the Cell Saver group was 453.8 mL. Patients in the Cell Saver group received significantly fewer allogenic blood transfusions than the Control group, with 32.6% less intraoperatively, 45.9% less postoperatively, and 47.3% less perioperatively. On average, Cell Saver patients received 1.0 fewer unit of allogenic blood compared to the Control group patients. CONCLUSION: Cell Saver reduces the demand for allogenic transfusion. This review supports the use of Cell Saver if the associated monetary costs are expected to be less than the cost of transfusing one unit of allogenic blood. LEVEL OF EVIDENCE: 4.
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