Cell Saver in Adult Spinal Deformity Surgery: Helping or Hurting?

While Cell Saver (CS) is meant to give patients back their own blood products in surgery, its quality has been called into question. To determine the safety of CS in adult spinal deformity (ASD) surgery, we sought to evaluate the impact CS on (1) intraoperative transfusions, (2) postoperative hematocrit, and (3) complications.

A retrospective cohort study (2009-23) was performed for patients undergoing ASD surgery. Inclusion criteria were ≥5-level fusion, sagittal/coronal deformity, and ≥2-year follow-up. Primary exposure was use of CS. Primary outcomes were (1) intraoperative transfusions, (2) postoperative hematocrit, and (3) overall complications. Secondary outcomes were intraoperative hypotension, defined as total minutes mean arterial pressure was <65 mm Hg, length of stay, and discharge status. Multivariable analysis controlled for age, sex, body mass index, and operative time.

Of 288 patients undergoing ASD surgery (mean age: 63 ± 18 years), 209 (73%) used CS. Mean CS given back was 428 ± 404 mL. CS use was associated with a longer operative time (442 ± 149 vs 382 ± 150 minutes, P = .003) and higher blood loss (1490 vs 765 mL, P < .001). The CS group paradoxically had higher intraoperative transfusion rates (68% vs 32%, P < .001) and blood product usage (3 ± 4 vs 1 ± 2 units, P < .001). Postoperative hematocrit was not different between groups (30 ± 4 vs 30 ± 5, P = .936). On multivariable regression, CS was independently associated with increased transfusions (odds ratio [OR] = 2.9, 95% CI: 1.6-5.5, P < .001) and medical complications (OR = 2.7, 95% CI: 1.0-7.0, P = .038). Multivariable regression analysis showed that CS was associated with longer intraoperative hypotension (β = 16.8, 95% CI: 3.8-29.7, P = .011) and higher odds of having mean arterial pressure <65 mm Hg for ≥90 minutes (OR = 3.3, 95% CI: 1.1-9.7, P = .032).

While controlling for operative time, CS use in ASD surgery was independently associated with increased intraoperative transfusions, medical complications, and prolonged hypotension without an improvement in postoperative hematocrit levels. Although giving patients back their own blood products seems beneficial, these data question the safety of CS use in ASD surgery.