BLOOD CONSERVATION IN ELECTIVE SPINAL FUSION SURGERY.

The risk of blood transfusion in spinal fusion surgery is significant and mandates efforts to reduce ABT. This prospective study demonstrated a significant reduction in the rate of allogeneic blood transfusion (ABT) using Cell Saver (CS), Preoperative Autologus Donation (PAD), and Preoperative Erythropoietin Therapy (PET). The ABT was inversely related to the number of modalities used: 74% (n=14/19) with zero modalities; 32% (n=24/74) with one modalities; 17% (n=9/52) with two modalities; and 7% (n=2/28) with three modalities. Due to the potential amount of blood loss during spinal fusions the use of several BC techniques in combination is required to effectively reduce ABT. The purpose of this prospective study is to assess the efficacy of current blood conservation (BC) techniques in reducing the rate of allogeneic blood transfusion (ABT) in spinal fusions. All three current blood conservation techniques, particularly in combination, proved to be very effective in reducing the rate of ABT in elective spinal fusions. Transfusion of allogenic blood despite its improved safety is not without risk. From June 1999 to September 2001, transfusion and related surgical data has been prospectively collected in one hundred and seventy-three patients undergoing elective spinal fusions. The following three BC techniques were utilized: Cell Saver (CS), Preoperative Auto-logus Donation (PAD), and Preoperative Erythropoietin Therapy (PET). The average number of fusion levels was 2.3 (range 1–5). The average estimated blood loss was 1725 milliliters (range 250–10700). Decompression was also preformed in 75% of cases. The overall ABT rate was 28% (n=49/173). The ABT was inversely related to the number of modalities used: 74% (n=14/19) with zero modalities; 32%* (n=24/74) with one modalities; 17%* (n=9/52) with two modalities; and 7%*† (n=2/28) with three modalities respectively (*statistically significant compared to zero modality group; † statistically significant compared to one modality group). The patient demographics and surgical variables were similar between the four groups. The use of CS, PAD, and PET was independently related to ABT. The risk of blood transfusion in spinal fusion surgery is significant and mandates efforts to reduce ABT. Due to the amount of blood loss the use of several BC techniques in combination is required to effectively reduce ABT.