Efficacy of intraoperative red blood cell salvage and autotransfusion in the treatment of acetabular fractures

Abstract

Objectives: To determine if cell saver (CS) use in patients with acetabular fractures reduces the volume or rate of allogeneic blood transfused intraoperatively and postoperatively and if this translated to a decrease in blood-related charges to the patient.

Design: Retrospective review.

Setting: Level 1 trauma center.

Patients: One hundred eighty-six patients with operatively treated acetabular fractures.

Intervention: All patients underwent open reduction internal fixation of their acetabular fracture. The decision to use CS was at the surgeon's discretion.

Main outcome measurements: The volume and rate of intraoperative and postoperative allogeneic blood transfused and blood-related charges were evaluated.

Results: CS was used in 60 cases (32%), and the average volume of blood autotransfused was 345 mL. No differences were observed in the rates (58.3% vs 48%, P = 0.1883) or the mean volumes (770 vs 518 mL, P = 0.0537) of intraoperative and postoperative allogeneic blood transfusions between the CS and the non-CS groups. Total blood-related charges in the CS group were significantly higher than that in the nonCS group ($1958 vs $694, P < 0.0001). Subanalyses based on fracture pattern, injury severity score, body mass index, days to surgery, and estimated blood loss were performed. In each subanalyses, no differences were observed in intraoperative and postoperative transfusion rates and volumes, and total blood-related charges were higher in the CS groups.

Conclusions: In the routine use of CS in acetabular surgery, there was no reduction in the volume or rate of allogeneic blood transfused intraoperatively or postoperatively. However, blood-related charges were significantly increased.