Cell salvage used in scoliosis surgery: is it really effective?

• Published in: World neurosurgery Vol. 101; pp. 568 - 576
• Main Authors: Liu, Jia-Ming, MD, Fu, Bi-Qi, Chen, Wen-Zhao, Chen, Jiang-Wei, MD, Huang, Shan-Hu, Liu, Zhi-Li, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017
• Subjects: Cell salvage; Humans; Intraoperative Complications - diagnosis; Intraoperative Complications - prevention & control; Meta-analysis; Neurosurgery; Operative Blood Salvage - methods; Operative Blood Salvage - trends; Randomized Controlled Trials as Topic - methods; Scoliosis; Scoliosis - diagnosis; Scoliosis - surgery; Transfusion; Treatment Outcome; cell salvage; RCT; OR; CI; RBCs; meta-analysis; transfusion; Mean difference; Confidence interval; randomized controlled trial; NOQAS; Newcastle-Ottawa Quality Assessment Scale; Red blood cells; Scoliosis; MD; Odds ratio; RBC; Transfusion; Cell salvage; Meta-analysis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.02.057

Abstract Background Scoliosis surgery is usually associated with large volume of intraoperative blood loss and cell salvage is commonly used to filter and retranfusion autologous blood to patients. However, the efficacy of using cell salvage in scoliosis surgery is still controversial. Objective The purpose of this study is to make clear that intraoperative use of cell salvage is effective to decrease the volume of perioperative allogenic blood transfusion in scoliosis surgery. Method A meta-analysis was conducted to identify the relevant studies from PubMed, EMbase, Medline, Cochrane library and Google scholar till July 2016. All randomized trials and controlled clinical studies comparing the clinical outcomes of using cell salvage versus noncell salvage in scoliosis surgery were retrieved for the meta-analysis. The data were analyzed by RevMan 5.3. Results A total of 7 studies with 562 patients were included in this meta-analysis. Based on the analysis, the volumes of perioperative and postoperative allogenic RBCs transfusion in cell salvage group were significantly less than those in control group ( P = 0.04 and P = 0.01). However, no significant difference was detected in the amount of intraoperative allogenic RBCs transfusion and the risk of patients needing allogenic blood transfusion between the two groups ( P = 0.14 and P = 0.61). Both the hemoglobin and hematocrit levels on the first day after surgery were significantly higher in cell salvage group than those in control group ( P = 0.002 and P < 0.001). But no significant differences were noted in neither hemoglobin nor hematocirt level at the time of discharge between the two groups ( P = 0.76 and P = 0.32). One of the included study reported the number of patients with complications related to transfusion in the two groups, which was not significant different ( P = 0.507). Conclusions Cell salvage significantly reduced the volumes of perioperative and postoperative allogenic RBCs transfusion in scoliosis surgery and increased the hemoglobin and hematocrit levels on the first day postoperatively. In addition, it seemed not increase the rate of transfusion complications during the surgery.