Objectives: An evaluation was made of the effectiveness of preoperative (preoperative autologous blood donation, PABD) and postoperative autologous blood salvage (shed blood salvage and reinfusion, PBSR) in reducing exposure to homologous blood transfusions (HBT) and transfusion-related complications in patients undergoing lumbar spine surgery. Patients and methods: The study population was a series of 122 consecutive patients who underwent instrumented lumbar spinal fusion (Allospine, Sulzer, Switzerland), divided into four groups depending on the transfusion regimen used. Group A (Control, homologous blood alone), Group B (PBSR), Group C (PABD), and Group D (PABD + PBSR). Shed blood was salvaged during the first 6 postoperative hours and reinfused using the ConstaVac CBCII device (Stryker, USA). The effectiveness (% of patients avoiding HBT) and use of autologous blood (% of collected autologous units reinfused) were evaluated, as well as the rate of postoperative complications. Results: Patients in group A (Control, n = 37) received only HBT (1.92 ± 0.2 U/pat), while those in group B (PBSR, n = 29) were reinfused 405 ± 29 ml/pat of shed blood (19 U, 74% of total postoperative blood loss) using the ConstaVac CBCII (Stryker). This reduced postoperative HBT requirements by 60% (0.28 vs. 0.67 U/pat, p < 0.05) and total HBT requirements by 20% (1.56 Vs 1.92 U/pat). Five patients in Group A and four in Group B did not receive HBT. The overall transfusion rate in Group B (2.25 ± 0.19) was not significantly different from that of Group A. In the next two groups, a 2 U/pat short-term PABD was obtained (7 days and 1 day before surgery) and used either alone (Group C, n = 24) or in combination with PBSR (Group D, n = 32). In group C, the transfusion requirement was 1.79 ± 0.1 U/pat, 83% of the PABD units was reinfused, and only two patients received HBT (effectiveness 93%). The patients in group D had the highest blood loss and lowest male/female ratio. In addition to 61 U of PABD (95%) and 24 U of PBSR (58% of total postoperative blood loss), 9 U of HBT were needed for 7 patients in Group D (effectiveness 78%), the mean transfusion rate being 3.03 ± 0.15 U/pat (p < 0.01). The overall effectiveness of the PABD program was 84% and only 11% of PABD units were not reinfused. There were no significant differences in preoperative, postoperative, and discharge hemoglobin levels, in the rate of infectious complications, or in the duration of hospitalization in the four groups. There were no clinically relevant adverse effects related to PABD or PBSR. Conclusions: Short-term PABD was found to be a safe and effective procedure for avoiding HBT in patients undergoing instrumented lumbar spinal surgery. The association of PBSR with PABD could be useful in patients who cannot donate the required number PABD units or when a large postoperative blood loss is anticipated.
|Translated title of the contribution||Autologous transfusion in surgery of the lumbar spine|
|Number of pages||10|
|Journal||Revista de Ortopedia y Traumatologia|
|Publication status||Published - 2001|