Intra-operative cell salvage in pelvic and acetabular fracture surgery: a retrospective comparative study

To determine if the intraoperative use of cell salvage (CS) led to a decrease in allogeneic blood transfusion by comparing with a control group that did not receive CS. We also looked at the effects of injury severity and surgical approach.

This was a retrospective study at a major trauma center. One hundred and nineteen patients underwent open reduction and internal fixation of pelvic and acetabular fractures with (59 patients) or without intra-operative blood cell salvage (60 patients). The main outcome measurements were allogeneic blood transfusion during and after surgery with respect to CS, injury severity and surgical approach.

We did not find any significant difference in the allogeneic blood transfusion between the CS and non-CS groups (rate-62% vs. 48%, p value 0.12 {significant at < 0.05}, volume 5.56 units vs. 5.58 units, p value 0.33). The rate (71.1% vs. 48.9%, p = 0.02) and volume (7.6 units vs. 4.3 units, p value 0.00057) of post-operative blood transfusion was significantly higher in the more severely injured (ISS > 20), but there was no significant difference between the CS and non-CS groups. No significant difference was seen between either patients who had anterior or posterior surgical approaches.

We did not find CS clearly efficacious clinically or cost effective, even in the more severely injured patients or when different surgical approaches were used. We do not advocate the routine use of CS in pelvic and acetabular surgery, but selectively, based on surgeon and patient preference.