Introduction: We set out to evaluate the efficacy and cost-effectiveness of cell saver in patients undergoing lumbar laminectomy and fusion.
Methods: 508 patients undergoing lumbar laminectomy and fusion in 3 or fewer levels were reviewed from our prospective spinal outcomes registry. Of these patients, 84 had cell-saver set-up and 57 had allogeneic transfusion without the use of cell saver. The use of cell saver technique did not exclude the use of allogeneic blood transfusion. The cost of each allogeneic unit of blood incurred by our hospital was $208. The cost to set up cell saver was $115.98. The cost to process the first unit of blood was $143.99 and each additional unit cost $8.42. Autogenous cell saver blood was not processed and transfused unless a minimum of 600 mL of blood was collected.
Results: 65 of 84 (77%) patients received cell saver autologous transfusion vs. 57 patients who received only allogeneic transfusion. There was no significant difference in blood loss or length of hospital stay between the two groups. In the cell saver group, the average amount of blood returned by autologous transfusion was 303 ± 209 mL and by allogeneic transfusion was 102 ± 236 mL. In the non-cell saver cohort, the average amount of blood transfused was 632 ± 317 mL. There were no transfusion related reactions in either cohort. There was no significant difference in the average transfusion related cost between cohorts ($326.34 ± 143.45 vs. $375.86 ± 188.63, p = 0.112). 19 patients who had cell saver set up did not receive an autologous transfusion accounting for an additional $2203.60 in cell-saver set up costs.
Conclusions: Cell saver autologous transfusion was not cost saving for patients undergoing lumbar laminectomy and fusion. If cell saver is utilized correctly, the cost of autologous vs. allogeneic transfusion is statistically similar.
Patient Care: This research will improve patient care by driving surgeons to utilize cell-saver only when a blood loss of greater than 750 mL occurs or can be predicted preoperatively. By using cell saver transfusion in such a manner, hospital cost savings can occur.
Learning Objectives: This abstract shows that cell-saver utilization does not result in a statistically significant decrease in costs as compared to allogeneic transfusion. There is a point at which cell-saver utilization does become cost efficient, at a blood loss of greater than 750 mL. This is based on ICER cut off scores of autologous vs. allogeneic transfusion.