The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery

Mahmoud Elmalky, Naveed Yasin, Ricardo Rodrigues-Pinto, John Stephenson, Craig Carroll, Glyn Smurthwaite, Rajat Verma, Saeed Mohammad, Irfan Siddique

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Context: Metastatic spine tumor surgery (MSTS) is associated with substantial blood loss, therefore leading to high morbidity and mortality. Although intraoperative cell salvage with leukocyte depletion filter (IOCS-LDF) has been studied as an effective means of reducing blood loss in other surgical settings, including the spine, no study has yet analyzed the efficacy of reinfusion of salvaged blood in reducing the need for allogenic blood transfusion in patients who have had surgery for MSTS. 

Purpose: This study aimed to analyze the efficacy, safety, and cost-effectiveness of using IOCS-LDF in MSTS. 

Study Design: This is a retrospective controlled study. Patient Sample A total of 176 patients undergoing MSTS were included in the study. 

Methods: All patients undergoing MSTS at a single center between February 2010 and December 2014 were included in the study. The primary outcome measure was the use of autologous blood transfusion. Secondary outcome measures included hospital stay, survival time, complications, and procedural costs. The key predictor variable was whether IOCS-LDF was used during surgery. Logistic and linear regression analyses were conducted by controlling variables such as tumor type, number of diseased vertebrae, approach, number and site of stabilized segments, operation time, preoperative anemia, American Society of Anesthesiologists (ASA) grade, age, gender, and body mass index (BMI). No funding was obtained and there are no conflicts of interest to be declared. 

Results: Data included 63 cases (IOCS-LDF) and 113 controls (non–IOCS-LDF). Intraoperative cell salvage with LDF utilization was substantively and significantly associated with a lower likelihood of allogenic blood transfusion (OR=0.407, p=.03). Intraoperative cell salvage with LDF was cost neutral (p=.88). Average hospital stay was 3.76 days shorter among IOCS-LDF patients (p=.03). Patient survival and complication rates were comparable in both groups. Conclusions We have demonstrated that the use of IOCS-LDF in MSTS reduces the need for postoperative allogenic blood transfusion while maintaining satisfactory postoperative hemoglobin. We recommend routine use of IOCS-LDF in MSTS for its safety, efficacy, and potential cost benefit.

Original languageEnglish
Pages (from-to)977-982
Number of pages6
JournalSpine Journal
Volume17
Issue number7
Early online date18 Mar 2017
DOIs
Publication statusPublished - 1 Jul 2017

Fingerprint

Cost-Benefit Analysis
Spine
Safety
Leukocytes
Neoplasms
Blood Transfusion
Length of Stay
Outcome Assessment (Health Care)
Autologous Blood Transfusions
Costs and Cost Analysis
Conflict of Interest
Anemia
Linear Models
Hemoglobins
Body Mass Index
Survival Rate
Retrospective Studies
Logistic Models
Regression Analysis
Morbidity

Cite this

Elmalky, Mahmoud ; Yasin, Naveed ; Rodrigues-Pinto, Ricardo ; Stephenson, John ; Carroll, Craig ; Smurthwaite, Glyn ; Verma, Rajat ; Mohammad, Saeed ; Siddique, Irfan. / The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery. In: Spine Journal. 2017 ; Vol. 17, No. 7. pp. 977-982.
@article{ca5bd51a82a347ebab30286bb52c2b50,
title = "The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery",
abstract = "Background Context: Metastatic spine tumor surgery (MSTS) is associated with substantial blood loss, therefore leading to high morbidity and mortality. Although intraoperative cell salvage with leukocyte depletion filter (IOCS-LDF) has been studied as an effective means of reducing blood loss in other surgical settings, including the spine, no study has yet analyzed the efficacy of reinfusion of salvaged blood in reducing the need for allogenic blood transfusion in patients who have had surgery for MSTS. Purpose: This study aimed to analyze the efficacy, safety, and cost-effectiveness of using IOCS-LDF in MSTS. Study Design: This is a retrospective controlled study. Patient Sample A total of 176 patients undergoing MSTS were included in the study. Methods: All patients undergoing MSTS at a single center between February 2010 and December 2014 were included in the study. The primary outcome measure was the use of autologous blood transfusion. Secondary outcome measures included hospital stay, survival time, complications, and procedural costs. The key predictor variable was whether IOCS-LDF was used during surgery. Logistic and linear regression analyses were conducted by controlling variables such as tumor type, number of diseased vertebrae, approach, number and site of stabilized segments, operation time, preoperative anemia, American Society of Anesthesiologists (ASA) grade, age, gender, and body mass index (BMI). No funding was obtained and there are no conflicts of interest to be declared. Results: Data included 63 cases (IOCS-LDF) and 113 controls (non–IOCS-LDF). Intraoperative cell salvage with LDF utilization was substantively and significantly associated with a lower likelihood of allogenic blood transfusion (OR=0.407, p=.03). Intraoperative cell salvage with LDF was cost neutral (p=.88). Average hospital stay was 3.76 days shorter among IOCS-LDF patients (p=.03). Patient survival and complication rates were comparable in both groups. Conclusions We have demonstrated that the use of IOCS-LDF in MSTS reduces the need for postoperative allogenic blood transfusion while maintaining satisfactory postoperative hemoglobin. We recommend routine use of IOCS-LDF in MSTS for its safety, efficacy, and potential cost benefit.",
keywords = "autologous transfusion, autotransfusion, blood loss in spinal metastatic surgeries, cell saver, intraoperative blood salvage autotransfusion, intraoperative cell salvage, leukocyte depletion filter, malignant tumor, tumor surgery",
author = "Mahmoud Elmalky and Naveed Yasin and Ricardo Rodrigues-Pinto and John Stephenson and Craig Carroll and Glyn Smurthwaite and Rajat Verma and Saeed Mohammad and Irfan Siddique",
year = "2017",
month = "7",
day = "1",
doi = "10.1016/j.spinee.2017.03.004",
language = "English",
volume = "17",
pages = "977--982",
journal = "Spine Journal",
issn = "1529-9430",
publisher = "Elsevier Inc.",
number = "7",

}

Elmalky, M, Yasin, N, Rodrigues-Pinto, R, Stephenson, J, Carroll, C, Smurthwaite, G, Verma, R, Mohammad, S & Siddique, I 2017, 'The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery', Spine Journal, vol. 17, no. 7, pp. 977-982. https://doi.org/10.1016/j.spinee.2017.03.004

The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery. / Elmalky, Mahmoud; Yasin, Naveed; Rodrigues-Pinto, Ricardo; Stephenson, John; Carroll, Craig; Smurthwaite, Glyn; Verma, Rajat; Mohammad, Saeed; Siddique, Irfan.

In: Spine Journal, Vol. 17, No. 7, 01.07.2017, p. 977-982.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The safety, efficacy, and cost-effectiveness of intraoperative cell salvage in metastatic spine tumor surgery

AU - Elmalky, Mahmoud

AU - Yasin, Naveed

AU - Rodrigues-Pinto, Ricardo

AU - Stephenson, John

AU - Carroll, Craig

AU - Smurthwaite, Glyn

AU - Verma, Rajat

AU - Mohammad, Saeed

AU - Siddique, Irfan

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background Context: Metastatic spine tumor surgery (MSTS) is associated with substantial blood loss, therefore leading to high morbidity and mortality. Although intraoperative cell salvage with leukocyte depletion filter (IOCS-LDF) has been studied as an effective means of reducing blood loss in other surgical settings, including the spine, no study has yet analyzed the efficacy of reinfusion of salvaged blood in reducing the need for allogenic blood transfusion in patients who have had surgery for MSTS. Purpose: This study aimed to analyze the efficacy, safety, and cost-effectiveness of using IOCS-LDF in MSTS. Study Design: This is a retrospective controlled study. Patient Sample A total of 176 patients undergoing MSTS were included in the study. Methods: All patients undergoing MSTS at a single center between February 2010 and December 2014 were included in the study. The primary outcome measure was the use of autologous blood transfusion. Secondary outcome measures included hospital stay, survival time, complications, and procedural costs. The key predictor variable was whether IOCS-LDF was used during surgery. Logistic and linear regression analyses were conducted by controlling variables such as tumor type, number of diseased vertebrae, approach, number and site of stabilized segments, operation time, preoperative anemia, American Society of Anesthesiologists (ASA) grade, age, gender, and body mass index (BMI). No funding was obtained and there are no conflicts of interest to be declared. Results: Data included 63 cases (IOCS-LDF) and 113 controls (non–IOCS-LDF). Intraoperative cell salvage with LDF utilization was substantively and significantly associated with a lower likelihood of allogenic blood transfusion (OR=0.407, p=.03). Intraoperative cell salvage with LDF was cost neutral (p=.88). Average hospital stay was 3.76 days shorter among IOCS-LDF patients (p=.03). Patient survival and complication rates were comparable in both groups. Conclusions We have demonstrated that the use of IOCS-LDF in MSTS reduces the need for postoperative allogenic blood transfusion while maintaining satisfactory postoperative hemoglobin. We recommend routine use of IOCS-LDF in MSTS for its safety, efficacy, and potential cost benefit.

AB - Background Context: Metastatic spine tumor surgery (MSTS) is associated with substantial blood loss, therefore leading to high morbidity and mortality. Although intraoperative cell salvage with leukocyte depletion filter (IOCS-LDF) has been studied as an effective means of reducing blood loss in other surgical settings, including the spine, no study has yet analyzed the efficacy of reinfusion of salvaged blood in reducing the need for allogenic blood transfusion in patients who have had surgery for MSTS. Purpose: This study aimed to analyze the efficacy, safety, and cost-effectiveness of using IOCS-LDF in MSTS. Study Design: This is a retrospective controlled study. Patient Sample A total of 176 patients undergoing MSTS were included in the study. Methods: All patients undergoing MSTS at a single center between February 2010 and December 2014 were included in the study. The primary outcome measure was the use of autologous blood transfusion. Secondary outcome measures included hospital stay, survival time, complications, and procedural costs. The key predictor variable was whether IOCS-LDF was used during surgery. Logistic and linear regression analyses were conducted by controlling variables such as tumor type, number of diseased vertebrae, approach, number and site of stabilized segments, operation time, preoperative anemia, American Society of Anesthesiologists (ASA) grade, age, gender, and body mass index (BMI). No funding was obtained and there are no conflicts of interest to be declared. Results: Data included 63 cases (IOCS-LDF) and 113 controls (non–IOCS-LDF). Intraoperative cell salvage with LDF utilization was substantively and significantly associated with a lower likelihood of allogenic blood transfusion (OR=0.407, p=.03). Intraoperative cell salvage with LDF was cost neutral (p=.88). Average hospital stay was 3.76 days shorter among IOCS-LDF patients (p=.03). Patient survival and complication rates were comparable in both groups. Conclusions We have demonstrated that the use of IOCS-LDF in MSTS reduces the need for postoperative allogenic blood transfusion while maintaining satisfactory postoperative hemoglobin. We recommend routine use of IOCS-LDF in MSTS for its safety, efficacy, and potential cost benefit.

KW - autologous transfusion

KW - autotransfusion

KW - blood loss in spinal metastatic surgeries

KW - cell saver

KW - intraoperative blood salvage autotransfusion

KW - intraoperative cell salvage

KW - leukocyte depletion filter

KW - malignant tumor

KW - tumor surgery

UR - http://www.scopus.com/inward/record.url?scp=85019370529&partnerID=8YFLogxK

U2 - 10.1016/j.spinee.2017.03.004

DO - 10.1016/j.spinee.2017.03.004

M3 - Article

VL - 17

SP - 977

EP - 982

JO - Spine Journal

JF - Spine Journal

SN - 1529-9430

IS - 7

ER -