The safety, efficacy and cost-effectiveness of intraoperative cell-salvage in metastatic spine tumour surgery

Background context
Metastatic spine tumour surgery (MSTS) is associated with substantial blood loss therefore leading to high morbidity and mortality. While intraoperative cell salvage with leucocyte depletion filter (IOCS-LDF) has been studied as an effective mean of reducing blood loss in other surgical settings, including the spine, no study has yet analysed the efficacy of re-infusion of salvaged blood in reducing the need for allogenic blood transfusion in patients who have had surgery for MSTS.

Purpose
To analyse the efficacy, safety and cost effectiveness of using IOCS-LDF in MSTS.

Study design/ Setting
Retrospective controlled study

Patient sample
176 patients undergoing MSTS

Methods
All patients undergoing MSTS at a single centre between February 2010 and December 2014 were included in the study. The primary outcome measure was the use of autologous blood transfusion. Secondary outcome measures included hospital stay, survival time, complications and procedural costs. The key predictor variable was whether or not IOCS-LDF was utilised during surgery. Logistic and linear regression analyses were conducted by controlling variables such as tumour type, number of diseased vertebrae, approach, number and site of stabilised segments, operation time, pre-operative anaemia, ASA grade, age, gender and BMI. No funding was obtained and there are no conflicts of interest to be declared.

Results
Data included 63 cases (IOCS-LDF) and 113 controls (non IOCS-LDF). IOCS-LDF utilisation was substantively and significantly associated with a lower likelihood of allogenic blood transfusion (OR=0.407, p=0.03). IOCS-LDF was cost neutral (p=0.88). Average hospital stay was 3.76 days shorter amongst IOCS-LDF patients (p=0.03). Patient survival and complication rates were comparable in both groups.

Conclusions
We have demonstrated that the use of IOCS-LDF in MSTS reduces the need for post-operative allogenic blood transfusion whilst maintaining satisfactory post-operative haemoglobin. We recommend routine use of IOCS-LDF in MSTS for its safety, efficacy and potential cost benefit.