EFFICACY AND COST CONSIDERATIONS OF INTRAOPERATIVE AUTOLOGOUS TRANSFUSION IN SPINAL-FUSION FOR IDIOPATHIC SCOLIOSIS WITH PREDEPOSITED BLOOD

Study Design. One hundred five patients with adolescent idiopathic sco liosis who underwent posterior spinal instrumentation and fusion with predeposited autologous blood, with or without intraoperative autologo us transfusion, were reviewed. Objective. To determine the benefit/non benefit of intraoperative autologous transfusion in diminishing the ne ed for homologous blood and influencing postoperative hematocrit value s in healthy adolescents undergoing spinal fusion for scoliosis. Summa ry of Background Data. A steady increase in the use of intraoperative autologous transfusion in recent years has occurred without guidelines regarding which procedures and patient populations would be best serv ed. Previous studies have failed to determine the cost effectiveness a nd actual reduction in homologous blood exposure attributable to intra operative autologous transfusion in adolescents who have undergone pre operative phlebotomy. Methods. Fifty-five adolescents (intraoperative autologous transfusion group) who underwent posterior instrumentation and fusion for idiopathic scoliosis with the use of an intraoperative autologous transfusion device were compared to 50 patients (control gr oup) who underwent the same procedure without the intraoperative autol ogous transfusion device. Results. The average percent salvage of red blood cells by the intraoperative autologous transfusion device was 35 %. The control group utilized significantly more of the predonated aut ologous blood than the intraoperative autologous transfusion group (1. 34 units/ case vs. 1.78 units/case, P < 0.05). Homologous blood usage was the same in both groups. Two patients in the intraoperative autolo gous transfusion group required nondirected homologous blood (total of four units), compared to three patients in the control group (total o f four units) (P = 0.048). Using multiple regression analysis, the tot al number of transfusions was significantly correlated with the estima ted blood loss and the duration of surgery in both groups. Postoperati ve hematocrit levels were slightly higher in the control group, but th ere was not a significant difference. Conclusions. The addition of int raoperative autologous transfusion to a preoperative phlebotomy progra m had no benefit on homologous blood exposure or postoperative hematoc rit changes in this population. Blood requirements for this procedure can be met less expensively and more reliably by merely donating one's own blood.