Background: Intraoperative cell salvage (IOCS) is widely used in cesarean section, and this study applied use of multi-center big data of IOCS in cesarean section to establish a bleeding risk assessment scale for IOCS patients. The purpose of this retrospective study was to explore the safety, health economy, and application guidelines of IOCS in obstetrics.
Methods: We included 2621 patients who received IOCS technology during cesarean section in 12 hospitals between January 2012 - January 2020. The patients were divided into two groups, Group A, intraoperative blood loss <1500 ml; Group B, intraoperative blood loss ≥1500 ml. The clinical and imaging data associated with the risk of bleeding in patients taking IOCS were collected, and multivariable logistic regression analysis was conducted to develop a scoring system.
Results: All patients who received IOCS in our study had no serious adverse outcomes. For the 2621 patients who take IOCS technology, while 407 cases not perform the blood transfusion, resulting in a waste rate of 15.5% for the resource. Multivariate logistic regression analysis was performed by selecting significant indicators from the univariate analysis and high-risk factors related to bleeding. The variables were maternal age ≥35 years, number of cesarean sections, placental attachment position, and placenta previa, each scored 1 point; placenta accreta, blood pool in the placenta, abnormal retroplacental myometrium, placenta protruding to the anterior uterine wall and continuous disruption of the myometrium, each scored 2 points; and cervical canal invasion, scored 4 points. All were risk factors for intraoperative blood loss volume ≥1500 ml in IOCS patients. A bleeding risk scoring system was constructed according to the above indicators. The area under the curve of the receiver operating characteristic curve (AUC) of the scoring system was 0.837, and a total score of 5 points was identified as the optimal cut-off value, allowing good differentiation of intraoperative massive bleeding in IOCS patients (AUC, 0.837; 95% confidence interval, 0.820–0.854), along with a sensitivity of 81.2% and specificity of 75.3%.
Conclusion: IOCS technology is a safe and effective measure to solve the problem of clinical blood source shortages in obstetric cesarean section. Moreover, the bleeding risk scoring system could better guide the clinical application of IOCS technology. Therefore, strictly mastering the clinical application guidelines of IOCS can save medical resources and reduce the economic burden on patients.