Application Value of Intraoperative Salvaged Autotransfusion during Posterior Lumbar Fusion: A Retrospective Study

doi:10.21203/rs.3.rs-1619439/v1

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Application Value of Intraoperative Salvaged Autotransfusion during Posterior Lumbar Fusion: A Retrospective Study

https://doi.org/10.21203/rs.3.rs-1619439/v1

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Objective: To understand the application value of intraoperative salvaged autotransfusion（ISA）during posterior lumbar decompression and fusion(PLDF) and transforaminal lumbar interbody fusion（TLIF）at ≥1 surgical segments.

Methods: Patients who underwent either procedure between January 2015 and January 2018 were enrolled. The patients were divided into two groups according to whether undergone ISA. Patient information, transfusion, clinical, and surgical data were analyzed for determine the clinical significance of ISA.

Results: 412 patients were enrolled into two groups:181 in the ISA group and 231 in the non-ISA group. The overall requirement and volumes for allogeneic blood were significantly lower in the ISA group. TLIF at ≥2 segments resulted in significantly lower usage rate of allogeneic blood in the ISA group. During PLDF , the usage rate and volumes of allogeneic blood in the ISA group were significantly lower in both 1 and ≥2 surgical segment numbers

Conclusion: The application value of ISA depends on the operation style and number of segments. During TLIF, ISA may not offer any additional clinical benefit in one segment, and the benefit in ≥ 2 segment should be invested further. During PLDF, in ISA group，the demand for allogeneic blood was reduced and patients own blood resources were effectively utilized regardless of surgical segment numbers.

Spinal Surgery

Lumbar vertebrae

Salvaged autotransfusion

Allogeneic Blood Transfusion

Intraoperative salvaged autotransfusion(ISA) is defined by auto uncontaminated blood during surgery is salvaged, washed, filtered, and reinfused^{[ 1]}. The clinical advantages of ISA are proven by reducing blood lost and no risk of immunological incompatibility, thereby shortening the durations of hospitalization through quicker postoperative recovery and without immune suppression. Therefore, the ISA is generally considered safe and effective^[2–4].

At present, ISA is universal used in cardiology and orthopedics^[5]. However, the application value during spinal surgery, and particularly posterior lumbar fusion (PLF) remains controversial. Spinal surgery is characteristic as large wounds, long operation times, massive bleeding loss, and large transfusion demand. Therefore, some experts recommend routine use of ISA^{[6, 7]}. Cha et al^[8] reported that ISA reduces allogeneic blood consume in PLF patients. However, this clinical effect is yet to be universally accepted^{[9, 10]}. Canan et al. ^[9]reported that the use of ISA during PLF at single segments would increase hospitalization costs. Further, Nd et al. ^[10]found that ISA did not lessen the amounts or rates of allogeneic blood demanding in patients undergoing lumbar spine surgery.

ISA has been carried out in our hospital since 2015. This study aims to retrospectively explore the application value of ISA during PLF between January 2015 and January 2018. Further, we aim to compare the benefits of ISA in posterior lumbar decompression and fusion (PLDF) and transforaminal lumbar interbody fusion (TLIF), also in different segments in this two operation respectively.

Patient Selection and Data Collection

A total of 489 PLF patients were retrospectively enrolled in this study at Shengjing Hospital of China Medical University between January 2015 and January 2018. The study was approved by the Ethics Committee(2018PS474K. All data were extracted from electronic medical record system. The following data relating to patient attributes and demographics were collected: age, sex, data regarding the occurrence of concomitant diseases or disorders and preoperative hemoglobin (Hb) levels were recorded. The following surgical data were extracted: type of surgical procedure conducted, surgical segments, operation time, intraoperative blood loss, blood transfusion method, intraoperative autologous blood input (if ISA had been performed), intraoperative and postoperative allogeneic blood transfusion volume and rate, duration of grade one nursing, length postoperative hospitalization. The types of surgical procedures included PLDF and TLIF.

Inclusion and Exclusion Criteria

Patients underwent PLF, either PLDF or TLIF was chose, the clinical data should be completely. Patients were excluded based by concomitant chronic diseases with potential coagulation changes (e.g., hematological diseases, immunological diseases, and rheumatism), preoperative anemia, administration of anticoagulants that had not reached the effective withdrawal time, the fused segments exceeded the lumbar spine sequence, neoplasia or infection.

Patient Grouping

Patients were grouped according to whether they underwent ISA or not; They were designated as the ISA group and non-ISA group, respectively. If the patient's predicted blood loss exceeds 400ml, salvaged autotransfusion device ready to run once the operation begun. ISA group as defined as the transfusion of autologous blood during surgery. In the non-ISA group, patients did not undergo autotransfusion, allogeneic blood was transfused when the blood loss was greater than 800 mL or the Hb level was less than 80 g/L as well as when manifestations of hypoxemia and anemia were present after the blood volume was corrected. Patients in each group were further stratified according to whether they underwent TLIF or PLDF and further stratified by surgery segments. The process of patient grouping and stratification is shown in Fig. 1.

Allogeneic blood input volume was calculated according to a 5 g/L increase of hemoglobin per unit of red blood cells (RBC). Some patients in the ISA group still had manifestations of hypoxemia and anemia even after ISA; therein, allogeneic blood was transfused according to the same protocol as in the non-ISA group.

Statistical Analysis

Statistical analysis was performed using the SPSS software version 17.0. Patient attributes data have been reported as mean ± standard deviation and were subjected to Chi-squared analysis. Normally distributed variables were analyzed using the paired t test, and those that were not normally distributed were analyzed using the rank-sum test. A p-value < 0.05 was considered statistically significant. A subgroup analysis was performed for ISA and non-ISA groups undergoing at different segments in both PLDF an TLIF.

Patient Data and Intergroup Comparisons

Based on the inclusion and exclusion criteria, 489 patients were consecutive surveyed, and 412 patients were finally enrolled. Among them, 181 patients (43.9%) underwent ISA and were included in the ISA group, 231 patients (56.1%) were included in the non-ISA group. The intraoperative blood loss in the ISA group was 644 ± 271 mL, the volume of reinfused autologous blood was 236 ± 112 mL, and the usage rate and average input volume of allogeneic blood were 13.3% and 53 ± 141 mL, respectively. In the non-ISA group, the intraoperative blood loss was 520 ± 195 mL, and the usage rate and average input volume of allogeneic blood were 32% and 141 ± 218 mL, respectively. Patient data are summarized in Table 1.

Table 1

Summary of patient data extracted from the electronic medical records of the 412 patients enrolled in the study. Patients were grouped according to whether they underwent ISA or not.
	ISA group(n = 181, 43.9%)	Non- ISA group (n = 231, 56.1%)	P
Age (years)	59.46 ± 8.68 (38–78)	58.32 ± 9.38 (41–76)	0.209
Sex (Male/Female)	91/90	109/122	0.4
BMI	24.36 ± 3.93 (21.2–34.6)	24.23 ± 3.94 (21.3–33.5)	0.796
Diabetes (n)	9	12	0.485
Hypertension (n)	22	16	0.086
Segments (1/2/3/4) (n)	120/56/4/1	155/73/3/0	0.564
Surgical procedure (PLDF/TLIF) (n)	115/66	145/86	0.478
Preoperative Hb (g/L)	138 ± 14 (105–163)	137 ± 15 (98–154)	0.702
Duration of operation (min)	206 ± 22 (102–430)	194 ± 59 (86–400)^*	0.026
Intraoperative blood loss (mL)	644 ± 271 (250–2200)	520 ± 195 (300–1500)^*	0.029
Reinfused volume of autologous blood (mL)	236 ± 112 (63–840)	-	-
Patients requiring allogeneic blood transfusion [n(%)]	24(13.3%)	74(32%)^**	0.000
Input volume of allogeneic blood (mL)	53 ± 141 (0-800)	141 ± 218 (0-800)^**	0.000
Duration of postoperative primary care (days)	3.99 ± 0.98 (3–8)	4.21 ± 1.47 (3–11)	0.072
Length of postoperative hospitalization (days)	9.58 ± 3.76 (3–19)	9.83 ± 3.50 (5–20)	0.48
p < 0.05,*p < 0.01. Abbreviations: BMI, body mass index; Hb, hemoglobin; PLDF, posterior lumbar decompression and fusion; TLIF, transforaminal lumbar interbody fusion

Stratification and Subgroup Analysis

To further clarify the application value of ISA in different surgical procedures and at different surgical segments, patients were divided into two subgroups according to TLIF or PLDF. Stratification analysis was performed on each subgroup according to surgical segment.

A total of 152 patients underwent TLIF and the usage rate and average input volume of allogeneic blood in the ISA group were not significantly different from those of the non- ISA group (P > 0.05). The data of patients who underwent TLIF are shown in Table 2.

Table 2

Data from 152 patients who underwent transforaminal lumbar interbody fusion (TLIF) grouped according to whether they also underwent ISA.
	ISA group (n = 66)	Non- ISA group (n = 86)	P
Age (years)	58.30 ± 8.90 (38–78)	58.22 ± 9.74 (40–76)	0.957
Sex (Male/Female)	27/39	35/51	0.979
BMI	24.5 ± 4.4 (21.3–34.6)	24.5 ± 2.8 (21.2–31.3)	0.98
Diabetes (n)	4	6	0.603
Hypertension (n)	8	3	0.056
Preoperative Hb (g/L)	136 ± 13 (106–158)	134 ± 15 (105–154)	0.342
Duration of operation (min)	191 ± 62 (110–430)	199 ± 59 (105–400)	0.391
Intraoperative blood loss (mL)	495 ± 180 (250–1100)	467 ± 137 (300–900)	0.309
Input volume of autologous blood (mL)	181 ± 834 (63–400)	-	-
Input volume of allogeneic blood (mL)	22 ± 90 (0-400)	54 ± 135 (0-400)	0.089
Patients requiring allogeneic blood transfusion [n(%)]	4(6%)	12(14%)	0.106
Duration of postoperative primary care (days)	3.98 ± 0.89 (3–6)	4.12 ± 1.55 (3–10)	0.51
Length of postoperative hospitalization (days)	8.92 ± 3.46 (4–19)	8.86 ± 2.91 (5–20)	0.906
Abbreviations: BMI, body mass index; Hb, hemoglobin

Of the 152 patients who underwent TLIF, 92 belonging to both the ISA and non-ISA groups underwent the procedure at one segment and did not require transfusion of allogeneic blood either intraoperatively or postoperatively. There was no significant difference in the duration of grade one nursing and length of hospitalization between 2 group (P > 0.05). The remaining 60 patients underwent TLIF at ≥ 2 segments, and there was no significant difference in the usage rate and average volume of allogeneic blood, duration of grade one nursing, and length of hospitalization between 2 group (P > 0.05). The comparison data of patients who underwent TLIF at different segments are shown in Table 3.

Table 3

Data from 152 patients who underwent transforaminal lumbar interbody fusion grouped according to the number of surgical segments and according to whether they also underwent intraoperative autotransfusion.
	1 segment		≥ 2 segments
	ISA group (n = 40)	Non- ISA group (n = 52)	ISA group (n = 26)	Non- ISA group (n = 34)
Age (years)	58 ± 8.5 (41–78)	57 ± 9.6 (43–75)	59 ± 9.6 (43–76)	59 ± 10.1 (41–74)
Sex (Male/Female)	15/25	21/31	12/14	14/20
BMI	25.1 ± 2.5 (21.3–33.5)	24.8 ± 2.5 (21.2–31.3)	24.4 ± 5.7 (22-34.6)	24.5 ± 2.1 (21.2–31.3)
Diabetes (n)	4	5	0	1
Hypertension (n)	6	2	2	1
Preoperative Hb (g/L)	136 ± 15 (105–162)	137 ± 15 (105–154)	138 ± 11 (118–161)	142 ± 16 (115–154)
Duration of operation (min)	164 ± 40 (102–330)	183 ± 58 (102–246)	232 ± 68 (152–400)	226 ± 50 (120–330)
Intraoperative blood loss (mL)	410 ± 105 (250–600)	393 ± 72 (300–600)	625 ± 195 (300–1100)	584 ± 132 (400–900)
Input volume of autologous blood (mL)	148 ± 47 (63–300)	-	232 ± 92 (85–440)	-
Input volume of allogeneic blood (mL)	0	0	57 ± 138 (0-400)	136 ± 188 (0-400)
Patients requiring allogeneic blood transfusion [n(%)]	0	0	4(15%)	12(35%)*
Duration of postoperative primary care (days)	3.9 ± 0.93 (3–6)	3.9 ± 1.46 (3–10)	4.1 ± 0.82 (3–6)	4.5 ± 1.62 (3–11)
Length of postoperative hospital stay (days)	8.4 ± 3.42 (4–14)	8.4 ± 2.76 (5–16)	9.8 ± 3.40 (4–15)	9.6 ± 3.03 (6–20)
*p < 0.05. Abbreviations: BMI, body mass index; Hb, hemoglobin

The remaining 260 patients underwent PLDF and the average usage rate and input volume of allogeneic blood in patients of the ISA group were significantly lower than those in the non-ISA group (P < 0.05). Further, the surgery time in the ISA group was longer than for patients in the non- ISA group (P < 0.05). These results are summarized in Table 4.

Table 4

Data from 260 patients who underwent posterior lumbar decompression and fusion grouped according to whether they also underwent ISA.
	ISA group (n = 115)	Non- ISA group (n = 145)	P
Age (years)	60.1 ± 8.5 (42–76)	58.4 ± 8.2 (41–76)	0.116
Sex (Male/Female)	64/51	74/71	0.284
BMI	24.6 ± 3.4 (21.2–32.8)	24.5 ± 3.8 (21.1–33.5)	0.807
Diabetes (n)	5	6	0.376
Hypertension (n)	14	13	0.515
Preoperative Hb (g/L)	139 ± 14 (105–159)	137 ± 15 (98–154)	0.226
Duration of operation (min)	203 ± 52 (102–350)	195 ± 57 (86–400)^*	0.030
Intraoperative blood loss (mL)	721 ± 271 (300–2200)	660 ± 238 (300–1500)	0.055
Input volume of autologous blood (mL)	266 ± 113 (80–840)	-	-
Input volume of allogeneic blood (mL)	71 ± 161 (0-800)	192 ± 242 (0-800)^**	0.000
Patients requiring allogeneic blood transfusion [n(%)]	20(17%)	62(43%)^**	0.000
Duration of postoperative primary care (days)	4 ± 1 (3–8)	4.3 ± 1.4 (3–11)	0.078
Length of postoperative hospitalization (days)	9.9 ± 3.9 (5–17)	10.4 ± 3.7 (3–17)	0.333
p < 0.05 ,*p < 0.01. Abbreviations: BMI, body mass index; Hb, hemoglobin

PLDF at one segment was performed in 183 of the 260 patients in this subgroup. Compared with the non-ISA group, the usage rate and average input volume of allogeneic blood in the ISA group were significantly lower (P < 0.05), and the duration of grade one nursing was significantly shortened (P < 0.05). The remaining 77 patients underwent PLDF at ≥ 2 segments, and the intraoperative blood loss of patients in the ISA group was significantly higher than in patients of the non-autotransfusion group (P < 0.05). However, the usage rate and average input volume of allogeneic blood in patients of the ISA group were significantly lower than those in patients of the non-ISA group (P < 0.05). The comparison data of patients in the ISA and non-ISA groups who underwent PLDF at different segments are shown in Table 5.

Table 5

Data from 183 patients who underwent posterior lumbar decompression and fusion grouped according to the number of surgical segments and according to whether they also ISA.
	1 segment		≥ 2 segments
	ISA group (n = 80)	Non- ISA group (n = 103)	ISA group (n = 35)	Non- ISA group (n = 42)
Age (years)	60 ± 9.3 (38–74)	59 ± 8.9 (41–76)	60 ± 6.3 (41–71)	58 ± 10.0 (44–72)
Sex (Male/Female)	46/34	53/50	18/17	21/21
BMI	24.7 ± 2.2 (21.2–31.3)	24.9 ± 2.2 (22.3–33.5)	24.1 ± 4.7 (21.5–31.1)	24.1 ± 5.9 (21.5–32)
Diabetes (n)	4	6	1	3
Hypertension (n)	11	10	3	3
Segments (2/>2)	-	-	31/4	39/3
Preoperative Hb (g/L)	139 ± 14 (110–158)	137 ± 15 (98–150)	139 ± 14 (114–163)	138 ± 15 (108–152)
Duration of operation (min)	202 ± 54 (120–350)	184 ± 48 (86–310)^*	222 ± 67 (120–430)	230 ± 41 (180–400)
Intraoperative blood loss (mL)	624 ± 189 (300–1200)	584 ± 206 (300–1300)	941 ± 304 (600–2200)	845 ± 203 (600–1500)^*
Input volume of autologous blood (mL)	228 ± 79 (80–393)	-	355 ± 129 (205–840)	-
Input volume of allogeneic blood (mL)	32 ± 105 (0-400)	126 ± 216 (0-800)^***	159 ± 223 (0-800)	354 ± 225 (0-800)^***
Patients requiring allogeneic blood transfusion [n(%)]	7(9%)	29(28%)^***	13(37%)	33(76%)^***
Duration of postoperative primary care (days)	3.9 ± 0.90 (3–6)	4.4 ± 1.58 (3–10)^**	4.3 ± 1.23 (3–8)	3.9 ± 0.87 (3–7)
Length of postoperative hospitalization (days)	9.6 ± 3.06 (3–14)	10.4 ± 4.03 (5–17)	10.7 ± 5.32 (4–19)	10.4 ± 2.76 (5–50)
p < 0.05,p < 0.01 ,**p < 0.001. Abbreviations: BMI, body mass index; Hb, hemoglobin

Previous studies have confirmed that ISA has many clinical advantages, including reducing allogeneic blood transfusion, lessening the occurrence of adverse reactions,^2–9 and ensure RBC oxygen-carrying ability^{[11, 12]}. Further, the use of autologous blood does not undergo immune suppression^{[13, 14]}. This allows for keep postoperative anti-infection ability^{[15, 16]}, all while having a minimal effect on the recipient’s self-regulated internal environment^[3].

It has been reported that the blood loss during lumbar fusion surgery accounts for 30–100% of the total blood volume^[17] and blood transfusion has become an important consideration for surgical success. The fulfillment of transfusion requirements in a timely underlies the success or failure of the operation. Surgical techniques are continuously being updated and there is a gradual promotion of minimally invasive surgery types such as TLIF. The goal of these developments is to enforce surgical procedures with small incisions, less complications, and less intraoperative bleeding. However, at present blood transfusions, cannot be completely avoided.

ISA is an effective means by which the requirement for allogeneic blood may be reduced. At present, ISA is widely applied in orthopedics, but the application value in PLF procedures remains controversial^{[9, 10]}. In this report, We aimed to find the usefulness of ISA over 3 years. The surgical procedures considered in this study are commonly applied in spinal correction and include PLDF and TLIF. We also sought to understand if there were differences in the clinical benefit of ISA depending on the number of surgical segments included in the procedure.

Of the 412 patients enrolled in our study, 181 (43.9%) had undergone ISA, suggesting that ISA is gaining clinical accepted. There was no difference in patient or clinical characteristics between the patients who underwent ISA or not, indicating that implementation of ISA is still not strictly. Further in-depth investigation is needed to identify patients most suitable for ISA so that its application can be targeted for optimal benefit.

The blood loss volume in the ISA group was slightly higher than that of the non- ISA group and the operation time were longer. We propose two reasons. First may be the patients in the ISA group underwent more surgical segments with three or four. The second is that in which intraoperative blood collection was associated with an increased operation time, which same as Gase et al^[18] opinions. However, the requirement for allogeneic blood transfusion was significantly lower in patients in the ISA group than in patients who received allogeneic blood only (13% vs. 32%, p < 0.05). Further, the average input volume of allogeneic blood in ISA group was significantly lower than in the non- ISA group (53 ± 141 mL vs. 141 ± 218 mL, p < 0.05). This observation suggests ISA may reduce overall demand for allogeneic blood in patients undergoing PLF thereby preserving blood resources^[19–21].

We further assessed patients from the two groups according to undergoing PLDF or TLIF. Of the 152 patients who underwent TLIF, 66 also underwent ISA. However, differences in the demand for further allogeneic blood transfusion between ISA group and no-ISA group were non-significant. Furthermore, there was no significant difference in input volume requirements for allogeneic blood between the two groups suggesting that ISA did not reducing allogeneic blood transfusion during TLIF.

In the patients underwent PLDF. The operation time for patients in the ISA group was longer than that for patients in the non-ISA group undergoing the same procedure, possibly because the salvage processing prolongs the total surgery time. The blood loss was higher in the ISA group than in the non-ISA group, although this difference was non-significant. The demand for further allogeneic blood and the average input volume in the ISA group was significantly lower than in the non-ISA group, suggesting that there is application value for ISA during PLDF.

Intraoperative blood loss volumes varied according to the number of surgical segments included in the procedures. Therefore, we further analyzed the two groups of patients according to the number of surgical segments included in each procedure-type. Previous studies have found that the ISA in PLF at one segment can reduce the demand for allogeneic blood^[9]. In our investigation, 92 patients underwent TLIF at one segment and 40 of these patients underwent ISA. Patients did not require allogeneic blood transfusion after TLIF at one segment regardless of the application of ISA, and the durations of grade one nursing and lengths of hospitalization were not significantly different between the two groups. We also found that the blood loss in TLIF at one segment was relatively small, and that patients from neither group reached the threshold for blood transfusion. In conclusion, ISA during TLIF at one segment did not notably change patient outcome but may increase hospitalization costs because of the need for special device and consumables, which may indicate ISA should not regular applied during TLIF at one segment .

In 60 patients undergoing TLIF at ≥ 2 segments, 26 patients also underwent ISA. Although no significant difference was found allogeneic blood used between the two groups, but the input volume and requirement for allogeneic blood in the ISA group was lower than in the non- ISA group. A larger sample size is needed to further explore this conclusion.

A total of 183 patients underwent PLDF at one segment and the demand and input volumes of allogeneic blood in the ISA group were significantly lower than those in the non-ISA group. The duration of grade one nursing was shorter for patients in the ISA group, suggesting that there is application value for ISA during PLDF at one surgical segment. In the further analysis of the 77 patients that underwent PLDF at ≥ 2 segments, the intraoperative blood loss of patients in the ISA group was higher than that of patients in the non- ISA group. The usage and input volumes of allogeneic blood in the ISA group were significantly lower than those in the non-ISA group suggesting that in patients undergoing PLDF at ≥ 2 segments, ISA was clinically valuable.

The use of ISA can reduce the occurrence of complications and shorten postoperative hospitalization^{[21, 22]}. Overall, our findings disagree with this observation with the exception of patients undergoing PLDF procedure at one segment wherein the duration of grading one nursing was lower than that of patients in the non-ISA group. All other differences in the duration of postoperative hospitalization and primary care were non-significant which agrees with the findings of Hong Kun-Hao et al^[23]. Therefore, the use of autologous blood in PLDF and TLIF has little effect on the length of hospital stay and the duration of primary care.

In conclusion, ISA is safe and effective when used in PLF. ISA may reduce the input volume and demand for allogeneic blood, but it may also increase the duration of operation. The application value of ISA is related to the procedure type and number of surgical segments. ISA is of little value during TLIF at one segment, and its application value during TLIF at 2 or more segments should be further explore. In contrast, PLDF at one segment and at ≥ 2 segments did benefit from ISA in that the usage requirements and input volumes of allogeneic blood were reduced through the effective utilization of patients’ own blood resources.

Acknowledgements

We would like to thank Editage (www.editage.cn) for English language editing.

All the authors declare no competing or conflicting interests

Study Approval and Informed Consent

This study was reviewed and approved by the Ethics Committee of Shengjing Hospital affiliated to China Medical University, Number as 2018PS474K

Ashworth A, Klein A A.Cell salvage as part of a blood conservation strategy in anaesthesia. Br J Anaesth.2010; doi: 10.1093/bja/aeq244.
Patil H, Garg N, Navakar D, Banabokade L. Clinical Experience of Autologous Blood Transfusion in Neurosurgery: Prospective Study in Central India. World Neurosurg. 2018;doi: 10.1016/j.wneu.2018.04.091.
Zacharias T, Ahlschwede E, Dufour N, Romain F, Theissen-Laval O. Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy: a propensity-score-matched case-control analysis. Can J Surg. 2018;doi: 10.1503/cjs.010017.
Sikorski RA, Rizkalla NA, Yang WW, Frank SM. Autologous blood salvage in the era of patient blood management. Vox San.2017; doi: 10.1111/vox.12527
Long MY,Liu ZH, Zhu JG. Comparative analysis of autologous blood transfusion and allogeneic blood transfusion in surgical patients. Int J Clin Exp Med.2014,7:2889–2894.
Oliveira JAA, Ramos RRM, Muniz Neto FJ, Almeida PC, Ramos MRF, Carvalho PST.Is cell salvage cost-effective in posterior arthrodesis for adolescent idiopathic scoliosis in the public health system? J Spine Surg. 2017; doi: 10.1055/s-0041-1732387
Elmalky M, Yasin N, Rodrigues-Pinto R, Stephenson J, Carroll C, Smurthwaite G, Verma R, Mohammad S, Siddique I. The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery. Spine J.2017;doi: 10.1016/j.spinee.2017.03.004.
Cha CW, Deible C, Muzzonigro T, Lopez-Plaza I, Vogt M, Kang JD. Allogeneic transfusion requirements after autologous donations in posterior lumbar surgeries. Spine.2002;doi: 10.1097/00007632-200201010-00023.
Canan C E, Myers J A, Owens R K, et al. Blood salvage produces higher total blood product costs in single-level lumbar spine surgery. Spine.2012;doi: 10.1097/BRS.0b013e3182767c8c.
Canan CE, Myers JA, Owens RK, Crawford CH 3rd, Djurasovic M, Burke LO, Bratcher KR, McCarthy KJ, Carreon LY. Predictive factors for the use of autologous cell saver transfusion in lumbar spinal surgery. Spine. 2013; doi:10.1097/BRS.0b013e3182767c8c.
Scott AV, Nagababu E, Johnson DJ, Kebaish KM, Lipsitz JA, Dwyer IM, Zuckerberg GS, Barodka VM, Berkowitz DE, Frank SM.2,3-Diphosphoglycerate Concentrations in Autologous Salvaged Versus Stored Red Blood Cells and in Surgical Patients After Transfusion. Anesth. Analg. 2016; doi: 10.1213/ANE.0000000000001071.
Nagababu E, Scott AV, Johnson DJ, Dwyer IM, Lipsitz JA, Barodka VM, Berkowitz DE, Frank SM. Oxidative stress and rheologic properties of stored red blood cells before and after transfusion to surgical patients.Transfusion.2016; doi: 10.1111/trf.13458.
Luo C, Luo X, He Y, Li J, Huang B, Lin L, Li Q. Impact of postoperative drainage autologous blood re-transfusion on the coagulation parameters and D-dimer levels of patients after total hip arthroplasty. Transfus Apher Sci.2016; doi: 10.1016/j.transci.2016.04.001.
Guo JR, Jin XJ, Yu J, Xu F, Zhang YW, Shen HC, Shao Y.Acute normovolemic hemodilution effects on perioperative coagulation in elderly patients undergoing hepatic carcinectomy. Asian Pac J Cancer Prev. 2013; doi: 10.7314/apjcp.2013.14.8.4529.
Zaw AS, Bangalore Kantharajanna S, Kumar N. Is Autologous Salvaged Blood a Viable Option for Patient Blood Management in Oncologic Surgery? Transfus Med Rev.2017; doi: 10.1016/j.tmrv.2016.06.003
Xu L, Shen J, Sun J, McQuillan PM, Hu Z. The Effects of Leukocyte Filtration on Cell Salvaged Autologous Blood Transfusion on Lung Function and Lung Inflammatory and Oxidative Stress Reactions in Elderly Patients Undergoing Lumbar Spinal Surgery. J Neurosurg Anesthesiol.2019; doi: 10.1097/ANA.0000000000000495.
Colomina MJ, Bagó J, Pellisé F, Godet C, Villanueva C. Preoperative erythropoietin in spine surgery. Eur Spine.2004; doi: 10.1007/s00586-004-0754-9.
Gause PR, Siska PA, Westrick ER, Zavatsky J, Irrgang JJ, Kang JD. Efficacy of intraoperative cell saver in decreasing postoperative blood transfusions in instrumented posterior lumbar fusion patients. Spine.2008; doi: 10.1097/BRS.0b013e3181657cc1.
Zacharias T, Ahlschwede E, Dufour N, Romain F, Theissen-Laval O. Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy: a propensity-score-matched case-control analysis. Can J Surg.2018;doi: 10.1503/cjs.010017.
Pawaskar A, Salunke AA, Kekatpure A, Chen Y, Nambi GI, Tan J, Sonawane D, Pathak S. Do autologous blood transfusion systems reduce allogeneic blood transfusion in total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc.2017; doi: 10.1007/s00167-016-4116-z.
Elmalky M, Yasin N, Rodrigues-Pinto R, Stephenson J, Carroll C, Smurthwaite G, Verma R, Mohammad S, Siddique I. The safety, efficacy and cost-effectiveness of intraoperative cell-salvage in metastatic spine tumour surgery. Spine J.2017; doi: 10.1016/j.spinee.2017.03.004.
Borghi B, Casati A. Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen. Eur J Anaesthesiol.2015;doi: 10.1046/j.1365-2346.2000.00693.x.
Hong KH, Pan JK, Yang WY, Luo MH, Xu SC, Liu J. Comparison between autologous blood transfusion drainage and closed-suction drainage/no drainage in total knee arthroplasty: a meta-analysis.BMC Musculoskelet Disord. 2016; doi: 10.1186/s12891-016-0993-z.

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Application Value of Intraoperative Salvaged Autotransfusion during Posterior Lumbar Fusion: A Retrospective Study

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Abstract

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Introduction

Materials And Methods

Patient Selection and Data Collection

Inclusion and Exclusion Criteria

Patient Grouping

Statistical Analysis

Results

Patient Data and Intergroup Comparisons

Stratification and Subgroup Analysis

Discussion

Declarations

References

Additional Declarations

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