Clinical efficacy and cost effectiveness of intraoperative cell salvage in pelvic trauma surgery

Introduction Pelvic acetabular injuries are associated with significant blood loss. This is compounded by multiple surgical interventions including definitive fracture fixation, which put patients at further risk of postoperative transfusion. We use intraoperative cell salvage routinely as a blood conservation strategy to address this issue. This is a prospective evaluation of the clinical efficacy and cost effectiveness of using intraoperative cell salvage in patients with pelvic acetabular injuries. Methods Data were collected prospectively for all the patients who underwent pelvic acetabular fracture fixation at our institution. A total of 30 patients (25 men, 5 women) with a mean age of 41 years (range: 31–79 years) were assessed over a period of 10 months. Results The mean preoperative and postoperative haemoglobin levels were 11.8g/dl and 9.9g/dl respectively. The mean intraoperative blood loss was 1,232.5ml (range: 150–2,693ml). The mean amount of blood salvaged and retransfused through a cell saver was 388ml. Of the 30 patients, 14 (47%) required transfusion after surgery and 26 units of blood were transfused. In terms of cost effectiveness, a total of £2,572 in 30 patients or £86 per patient were saved. Conclusions We found intraoperative cell salvage to be clinically efficacious and cost effective in patients with pelvic acetabular injuries.

Download Full-text

Clinical efficacy and cost-effectiveness of intra-operative cell salvage in pelvic trauma surgery

Injury Extra ◽

10.1016/j.injury.2011.06.291 ◽

2011 ◽

Vol 42 (9) ◽

pp. 127

Author(s):

S. Odak ◽

A. Raza ◽

N. Shah ◽

A. Clayson

Keyword(s):

Cost Effectiveness ◽

Clinical Efficacy ◽

Trauma Surgery ◽

Pelvic Trauma ◽

Cell Salvage

Download Full-text

Nonstructural bone graft for single-segment lumbar tuberculosis: surgical indications, clinical efficacy, and preliminary experiences in 34 patients

Journal of International Medical Research ◽

10.1177/0300060520982780 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098278

Author(s):

Xing Du ◽

Yunsheng Ou ◽

Guanyin Jiang ◽

Yong Zhu ◽

Wei Luo ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Bone Graft ◽

Cobb Angle ◽

Clinical Efficacy ◽

Operative Time ◽

Bone Grafts ◽

Surgical Indications ◽

Operative Blood Loss ◽

The Mean

Objective This study was performed to evaluate the surgical indications, clinical efficacy, and preliminary experiences of nonstructural bone grafts for lumbar tuberculosis (TB). Methods Thirty-four patients with lumbar TB who were treated with nonstructural bone grafts were retrospectively assessed. The operative time, operative blood loss, hospital stay, bone graft fusion time, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, visual analog scale (VAS) score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment grade, and Cobb angle were recorded and analyzed. Results The mean operative time, operative blood loss, hospital stay, Cobb angle correction, and Cobb angle loss were 192.59 ± 42.16 minutes, 385.29 ± 251.82 mL, 14.91 ± 5.06 days, 9.02° ± 3.16°, and 5.54° ± 1.09°, respectively. During the mean follow-up of 27.53 ± 8.90 months, significant improvements were observed in the ESR, CRP concentration, VAS score, ODI, and ASIA grade. The mean bone graft fusion time was 5.15 ± 1.13 months. Three complications occurred, and all were cured after active treatment. Conclusions Nonstructural bone grafts may achieve satisfactory clinical efficacy for appropriately selected patients with lumbar TB.

Download Full-text

Economic analysis of the implementation of autologous transfusion technologies throughout England

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462305050312 ◽

2005 ◽

Vol 21 (2) ◽

pp. 234-239 ◽

Cited By ~ 10

Author(s):

Simon Dixon ◽

Virge James ◽

Daniel Hind ◽

Craig J. Currie

Keyword(s):

Policy Development ◽

Large Scale ◽

Future Research ◽

Cell Salvage ◽

Autologous Transfusion ◽

The United Kingdom ◽

Intraoperative Cell Salvage ◽

The Mean ◽

The Cost ◽

Preoperative Autologous Donation

Objectives:This study aims to provide the first estimates of the costs and effects of the large scale introduction of autologous transfusion technologies into the United Kingdom National Health Service.Methods:A model was constructed to allow disparate data sources to be combined to produce estimates of the scale, costs, and effects of introducing four interventions. The interventions considered were preparing patients for surgery (PPS) clinics, preoperative autologous donation (PAD), intraoperative cell salvage (ICS), and postoperative cell salvage (PoCS).Results:The key determinants of cost per operation are the anticipated level of reductions in blood use, the mean level of blood use, mean length of stay, and the cost of the technology. The results show the potential for considerable reductions in blood use. The greatest reductions are anticipated to be through the use of PPS and ICS. Vascular surgery, transplant surgery, and cardiothoracic surgery appear to be the specialties that will benefit most from the technologies.Conclusions:Several simplifications were used in the production of these estimates; consequently, caution should be used in their interpretation and use. Despite the drawbacks in the methods used in the study, the model shows the scale of the issue, the importance of gathering better data, and the form that data must take. Such preliminary modeling exercises are essential for rational policy development and to direct future research and discussion among stakeholders.

Download Full-text

Trial of intraoperative cell salvage versus transfusion in ovarian cancer (TIC TOC): protocol for a randomised controlled feasibility study

BMJ Open ◽

10.1136/bmjopen-2018-024108 ◽

2018 ◽

Vol 8 (11) ◽

pp. e024108 ◽

Cited By ~ 1

Author(s):

Khadra Galaal ◽

Alberto Lopes ◽

Colin Pritchard ◽

Andrew Barton ◽

Jennifer Wingham ◽

...

Keyword(s):

Ovarian Cancer ◽

Blood Transfusion ◽

Controlled Trial ◽

Cancer Surgery ◽

Conservation Strategy ◽

Adult Women ◽

Cell Salvage ◽

Donor Blood ◽

Intraoperative Cell Salvage ◽

Randomised Controlled

IntroductionOvarian cancer is the leading cause of death from gynaecological cancer, with more than 7000 new cases registered in the UK in 2014. In patients suitable for surgery, the National Institute of Health and Care Excellence guidance for treatment recommends surgical resection of all macroscopic tumour, followed by chemotherapy. The surgical procedure can be extensive and associated with substantial blood loss which is conventionally replaced with a donor blood transfusion. While often necessary and lifesaving, the use of donor blood is associated with increased risks of complications and adverse surgical outcomes. Intraoperative cell salvage (ICS) is a blood conservation strategy in which red cells collected from blood lost during surgery are returned to the patient thus minimising the use of donor blood. This is the protocol for a feasibility randomised controlled trial with an embedded qualitative study and feasibility economic evaluation. If feasible, a later definitive trial will test the effectiveness and cost-effectiveness of ICS reinfusion versus donor blood transfusion in ovarian cancer surgery.Methods and analysisSixty adult women scheduled for primary or interval ovarian cancer surgery at participating UK National Health Service Trusts will be recruited and individually randomised in a 1:1 ratio to receive ICS reinfusion or donor blood (as required) during surgery. Participants will be followed up by telephone at 30 days postoperatively for adverse events monitoring and by postal questionnaire at 6 weeks and 3 monthly thereafter, to capture quality of life and resource use data. Qualitative interviews will capture participants’ and clinicians’ experiences of the study.Ethics and disseminationThis study has been granted ethical approval by the South West–Exeter Research Ethics Committee (ref: 16/SW/0256). Results will be disseminated via peer-reviewed publications and will inform the design of a larger trial.Trial registration numberISRCTN19517317.

Download Full-text

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

The Spine Journal ◽

10.1016/j.spinee.2017.03.004 ◽

2017 ◽

Vol 17 (7) ◽

pp. 977-982 ◽

Cited By ~ 10

Author(s):

Mahmoud Elmalky ◽

Naveed Yasin ◽

Ricardo Rodrigues-Pinto ◽

John Stephenson ◽

Craig Carroll ◽

...

Keyword(s):

Cost Effectiveness ◽

Tumor Surgery ◽

Cell Salvage ◽

Spine Tumor ◽

Intraoperative Cell Salvage ◽

Metastatic Spine Tumor ◽

Spine Tumor Surgery

Download Full-text

Efficacy of Intraoperative Blood Salvage in Cerebral Aneurysm Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10245734 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5734

Author(s):

Bedjan Behmanesh ◽

Florian Gessler ◽

Elisabeth Adam ◽

Ulrich Strouhal ◽

Sae-Yeon Won ◽

...

Keyword(s):

Cost Effectiveness ◽

Blood Cell ◽

Cerebral Aneurysm ◽

Red Blood Cell ◽

Cerebral Aneurysms ◽

Cell Salvage ◽

Aneurysm Surgery ◽

Allogenic Blood ◽

Intraoperative Cell Salvage ◽

Unruptured Cerebral Aneurysm

Background. The use and effectiveness of intraoperative cell salvage has been analyzed in many surgical specialties. Until now, no data exist evaluating the efficacy of intraoperative cell salvage in cerebral aneurysm surgery. Aim. To evaluate the efficacy and cost effectiveness of intraoperative cell salvage in cerebral aneurysm surgery. Methods. Data were collected retrospectively for all the patients who underwent cerebral aneurysm surgery at our institution between 2013 and 2019. Routinely, we apply blood salvage through autotransfusion. The cases were divided into a ruptured cerebral aneurysm group and a unruptured cerebral aneurysm group. Results. A total of 241 patients underwent cerebral aneurysm clipping. Of all the cerebral aneurysms, 116 were ruptured and 125 were unruptured and clipped electively. Age, location of the aneurysm, postoperative red blood cell count, intraoperative blood loss, and number of allogenic blood cell transfusions were statistically significantly different between the groups. The autotransfusion of salvaged blood could only be facilitated in eight cases with ruptured cerebral aneurysms and in none with unruptured cerebral aneurysms clipped electively (p < 0.01). Additionally, 35 patients with ruptured cerebral aneurysms and one patient with unruptured cerebral aneurysm required allogenic red blood cell transfusion after surgery, and 71 vs. 2 units of blood were transfused (p < 0.0001). In terms of cost effectiveness, a total of EUR 45,189 in 241 patients was spent to run the autotransfusion system, while EUR 13,797 was spent for allogenic blood transfusion. Conclusions. The use of cell salvage in patients with unruptured cerebral aneurysm, undergoing elective surgery, is not effective.

Download Full-text

Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section: results from a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2018-022352 ◽

2019 ◽

Vol 9 (2) ◽

pp. e022352 ◽

Cited By ~ 4

Author(s):

Carol McLoughlin ◽

Tracy E Roberts ◽

Louise J Jackson ◽

Philip Moore ◽

Matthew Wilson ◽

...

Keyword(s):

Cost Effectiveness ◽

Caesarean Section ◽

Blood Transfusion ◽

Controlled Trial ◽

Mean Difference ◽

Cell Salvage ◽

Donor Blood ◽

Intention To Treat ◽

The Mean ◽

Randomised Controlled

ObjectivesTo evaluate the cost-effectiveness of routine use of cell salvage during caesarean section in mothers at risk of haemorrhage compared with current standard of care.DesignModel-based cost-effectiveness evaluation alongside a multicentre randomised controlled trial. Three main analyses were carried out on the trial data: (1) based on the intention-to-treat principle; (2) based on the per-protocol principle; (3) only participants who underwent an emergency caesarean section.Setting26 obstetric units in the UK.Participants3028 women at risk of haemorrhage recruited between June 2013 and April 2016.InterventionsCell salvage (intervention) versus routine care without salvage (control).Primary outcome measuresCost-effectiveness based on incremental cost per donor blood transfusion avoided.ResultsIn the intention-to-treat analysis, the mean difference in total costs between cell salvage and standard care was £83. The estimated incremental cost-effectiveness ratio (ICER) was £8110 per donor blood transfusion avoided. For the per-protocol analysis, the mean difference in total costs was £92 and the ICER was £8252. In the emergency caesarean section analysis, the mean difference in total costs was £55 and the ICER was £13 713 per donor blood transfusion avoided. This ICER is driven by the increased probability that these patients would require a higher level of postoperative care and additional surgeries. The results of these analyses were shown to be robust for the majority of deterministic sensitivity analyses.ConclusionsThe results of the economic evaluation suggest that while routine cell salvage is a marginally more effective strategy than standard care in avoiding a donor blood transfusion, there is uncertainty in relation to whether it is a less or more costly strategy. The lack of long-term data on the health and quality of life of patients in both arms of the trial means that further research is needed to fully understand the cost implications of both strategies.Trial registration numberISRCTN66118656.

Download Full-text

Cost-effectiveness Analysis of Intraoperative Cell Salvage for Obstetric Hemorrhage

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000547303.95433.a2 ◽

2018 ◽

Vol 38 (4) ◽

pp. 204-205

Author(s):

G. Lim ◽

V. Melnyk ◽

F.L. Facco ◽

J.H. Waters ◽

K.J. Smith

Keyword(s):

Cost Effectiveness ◽

Cost Effectiveness Analysis ◽

Cell Salvage ◽

Obstetric Hemorrhage ◽

Intraoperative Cell Salvage ◽

Effectiveness Analysis

Download Full-text

Intraoperative cell salvage versus postoperative autologous blood transfusion in hip arthroplasty: a retrospective service evaluation

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x579801 ◽

2011 ◽

Vol 93 (5) ◽

pp. 398-400 ◽

Cited By ~ 6

Author(s):

L Mason ◽

C Fitzgerald ◽

J Powell-Tuck ◽

R Rice

Keyword(s):

Blood Loss ◽

Hip Arthroplasty ◽

Autologous Blood ◽

Service Evaluation ◽

Autologous Blood Transfusion ◽

Cell Salvage ◽

Total Hip ◽

Intraoperative Cell Salvage ◽

Group A ◽

Group B

INTRODUCTION A number of ways of reducing blood loss in arthroplasty have been explored, including preoperative autologous transfusion, intraoperative cell salvage and postoperative autologous transfusions. Both intraoperative blood salvage and postoperative retransfusion drains have been shown to be effective in reducing blood loss in total hip arthroplasty. In our department there was a change in practice from using postoperative retransfusion drains to intraoperative cell salvage. To our knowledge no study has directly compared using intraoperative blood salvage and postoperative retransfusion drains alone in total hip arthroplasty. METHODS This was a retrospective service evaluation including all primary hip arthroplasty performed under our care between January 2006 and December 2008. Patients were divided into two groups: Group A used a postoperative autologous blood transfusion (ABT) drain and Group B used intraoperative cell salvage. RESULTS A total of 144 patients were included in this study: 84 in Group A and 60 in Group B. The mean haemoglobin difference for Group A was 3.96g/dl (standard deviation [SD]: 1.52) and for Group B it was 3.46g/dl (SD: 1.42). The mean haematocrit difference for Group A was 0.12% (SD: 0.05) and for Group B it was 0.10% (SD: 0.04). Using an independent t-test for the comparison of means, a significant difference was found between Group A and B both in regards to haemoglobin difference (p=0.009) and haematocrit difference (p=0.046). CONCLUSIONS We feel that intraoperative cell salvage provides a more efficient method of reducing blood loss than postoperative retransfusion in primary total hip replacement. A prospective randomised study would be useful to ascertain any clinical difference between the two methods.

Download Full-text