Packed Red Blood Cells with Cell Saver Return versus Packed Red Blood Cells-Only is Efficacious and Safe in Long-Segment Adult Spinal Deformity Correction Surgery: A Propensity-Score Matched Analysis
Research Fellow Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, US
Introduction: Cell saver return is increasingly used in long-segment posterior spinal fusion (PSF) for adult spinal deformity (ASD). Recent studies have demonstrated morphological differences in cell saver quality compared to packed red blood cells (pRBC). This study aimed to investigate the efficacy and safety of pRBCs with cell saver return compared to pRBC-only.
Methods: The design and reporting of this study were supported by the STROBE guideline. Patients undergoing PSF were identified in our institutional deformity registry. Inclusion criteria were patients with PSF of 6 or more vertebrae, thoracolumbosacral region, and ASD. Patients with a cervical component in the fusion construct and non-deformity indication were excluded. Propensity-score matching (PSM) with a 1:1 ratio was applied to balance for confounding factors. Covariates included demographics, baseline characteristics, surgical details, estimated blood loss (EBL) and total transfusion volume. Primary outcomes included any post-operative complications (binary), post-operative transfusion requirements, length of stay (LOS), intensive care unit (ICU) LOS, 30-day readmissions, and reoperation rates. Secondary outcomes included exploration of peri-operative outcomes including operative time, post-operative complication types, re-operation indications, disposition, and post-operative patient-reported outcome metrics (PROMs). Benjamini-Hochberg correction was applied to correct for multiplicity.
Results: 646 patients were included in the analysis. After PSM there were 99 pairs that were well balanced, totaling 198 patients. There were no significant differences in primary and secondary outcomes before and after adjusting for multiplicity testing (P>0.05). The intra-operative pRBC transfusion volume was lower in the combined group (mean difference 276.1 mL, P=0.012).
Conclusion : In this PSM study of long-segment PSF for ASD, no significant differences were found between pRBCs with cell saver return and pRBC-only in peri-operative outcomes. These findings, along with the observed reduction in intraoperative pRBC transfusion volume suggest that cell saver return is non-inferior to pRBC-only with respects to peri-operative outcomes.