Are 90-Day Postoperative Cardiopulmonary Complications Related to Intraoperative Cell Saver Utilization during Adult Spinal Deformity Surgery?

Introduction: Adult Spinal Deformity (ASD) surgeries are notable for their risk of major blood loss. Cell Saver (CS) uses each patient’s own RBCs to re-administer blood intraoperatively. Recent literature has noted that high CS volumes (>550 mL) may be correlated with early postop medical complications. The aim of this study was to investigate if high CS volumes (CS > 550 mL) are associated with cardiopulmonary complications (CPCs) in the early postop period (i.e. 90 days).

Methods: 228 ASD patients who underwent surgery at a single center from 2015-2021 with >1.5L EBL and >4 levels of fusion who received CS were identified. 7 patients had no documented volume of cell saver and were excluded from analysis. Ages ranged from 18-77 yrs. 2 groups were stratified: high CS (CS > 550 mL) and low CS (CS ≤ 550 mL). Demographics, intra-/postop transfusion data, 90-day readmission/reop rates, and CPCs were collected. Multi-logistic regression was utilized to identify relationships between intraop CS and 90-day postop CPCs, and readmissions/reoperations. SPSS 28.0.0.0. was utilized to conduct all analysis.

Results: Average age at surgery was 51.9 yrs, 154 pts were female (68%) and 74 were male (32%). 151 pts were in the high CS group (66%) and 77 pts were in the low CS group (34%). Out of 228 ASD pts, 65/228 (28.5%) had anemia, 19/228 (8%) had thrombocytopenia, 74/228 (32%) had hypotension, 9/228 (4%) had VTE, 44/228 (19.2%) had PE/vascular congestion/ARDS, and 30/228 (13%) had atelectasis/pneumothorax (13%). 34/228 (15%) had a reoperation while 41/228 (18%) of pts were readmitted. Age at surgery, total instrumented levels (TIL), packed RBCs transfused, and EBL were adjusted for. Multi-logistic regression showed that intraop CS > was not significant for anemia, thrombocytopenia, VTE, PE/vascular congestion/ARDS, atelectasis/pneumothorax, 90 day readmissions/reoperations (p=.315). However, CS > 550 mL was associated with hypotension (p=.005, 95% CI = [1.367, 6.137]).

Conclusion : High CS volumes administered during ASD surgeries are not positively correlated with most CPCs. However, CS volumes > 550 mL may induce hypotension in the early postop phase in pts undergoing ASD correction.