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BACKGROUND: The rate of patient-related clinical adverse events (AEs) associated with the use of intraoperative cell salvage (ICS) was analyzed. STUDY DESIGN AND METHODS: The perfusion service and electronic risk management databases in a nine-hospital regional health care system were reviewed over an approximately 11-year period. The number of ICS cases performed during this period and basic patient demographics were also extracted. RESULTS: There were 43,198 patients for whom ICS was utilized during the study period. Recovered blood was returned to 33,351 (77.2%) patients. Electronic comments on the ICS procedure were found in 2348 of 33,351 (7.0%) cases. The vast majority of comments (2203/2348, 93.8%) described minor events that did not lead to patient-related AEs such as the surgeon requested higher than normal suction pressure or that no RBCs were returned. Only 144 of 2348 (6.1%) of the comments described procedural or equipment-related events or potential AEs. From these comments two potential AEs were identified: the first was a post-Cesarean section patient who became acutely tachycardic, hypertensive, and dyspneic with rigors. The second was a patient with postpartum hemorrhage who experienced acute dyspnea and hypotension. Both patients were rapidly stabilized and discharged from the hospital shortly thereafter without further complications. It is unclear if these events were caused by ICS reinfusion. No air emboli were reported. The overall rate of patient-related AEs associated with ICS reinfusion was between 0 and 2 per 33,351 (0%-0.006%). CONCLUSIONS: The use of ICS is safe with a very low rate of patient-related AEs.

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Modified ultrafiltration (MUF) is available for the salvage of post-cardiopulmonary bypass circuit blood. This study evaluated the extent of hemolysis, the mechanical fragility index (MFI), and the amount of plasma free hemoglobin (PFHb) created after processing with the MUF device. Several RBC parameters were measured on pre- and post-MUF device processed samples of blood from 12 patients undergoing cardiac surgery. The MFI and total amount of PFHb did not change significantly between the pre- and post-processing samples: MFI, pre: .19 +/- .06 versus post: .19 +/- .06, p = .76; total amount of PFHb, pre: .24 +/- .21 g versus post: .20 +/- .12 g, p = .42. There was significantly more hemolysis in the post-processing samples compared with the pre-processing samples, .33 +/- .24% versus .96 +/- .48%, respectively, p < .001. Although percent hemolysis was increased following processing with the MUF device, the total amount of PFHb and RBC sublethal injury were not increased. The clinical significance of these findings needs to be determined.

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BACKGROUND: The increasing costs, limited supply, and clinical risks associated with allogeneic blood transfusion have prompted investigation into autologous blood management strategies, such as postoperative red blood cell (RBC) salvage. This study provides a cost comparison of transfusing washed postoperatively salvaged RBCs using an orthopedic perioperative autotransfusion device (OrthoPat, Haemonetics Corporation) versus unwashed shed blood and banked allogeneic blood. STUDY DESIGN AND METHODS: Cell salvage data were retrospectively reviewed for a sample of 392 patients who underwent primary hip or knee arthroplasty. Mean unit costs were calculated for washed salvaged RBCs, equivalent units of unwashed shed blood, and therapeutically equivalent volumes of allogeneic RBCs. RESULTS: No initial capital investment was required for the establishment of the postoperative cell salvage program. For patients undergoing total knee arthroplasty (TKA), the mean unit costs for washed postoperatively salvaged cells, unwashed shed blood, and allogeneic banked blood were $758.80, $474.95, and $765.49, respectively. In patients undergoing total hip arthroplasty (THA), the mean unit costs for washed postoperatively salvaged cells, unwashed shed blood, and allogeneic banked blood were $1827.41, $1167.41, and $2609.44, respectively. CONCLUSION: This analysis suggests that transfusing washed postoperatively salvaged cells using the OrthoPat device is more costly than using unwashed shed blood in both THA and TKA. When compared to allogeneic transfusion, washed postoperatively salvaged cells carry a comparable cost in TKA, but potentially represent a significant savings in patients undergoing THA. Sensitivity analysis suggests that in the case of TKA, however, cost comparability exists within a narrow range of units collected and infused.

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BACKGROUND: Intraoperative blood salvage is the process whereby shed red blood cells (RBCs) are collected and returned to the patient. We analyzed the trends in the volume of returned RBCs by our blood salvage program across a 12-hospital regional health care system over a 5-year period. STUDY DESIGN AND METHODS: All quality control, RBC recovery, and patient demographic data relating to blood salvage are stored in a large database covering these 12 hospitals. Cases in which blood salvage was performed over a 5-year period were stratified based on patient demographics, hospital, type of surgery, and volume of RBCs recovered. RESULTS: There were 19,867 surgeries performed during the study period in which blood salvage was used. The median volume of blood returned to each patient was 405 mL (25th-75th percentile, 135-750 mL). Defining the volume of an RBC unit as 200 mL, this represented a median of 1.1 RBC unit equivalents (25th-75th percentile, 0.37-2.1 units) returned to each patient. For the majority of patients, not more than 1 RBC unit equivalent was recovered. Overall, the ratio of cases where at least 1 RBC unit equivalent was recovered to cases where less than 1 RBC equivalent was recovered was 2.5:1; this ratio varied considerably between surgical procedures. CONCLUSIONS: Although overall the mean volumes of RBCs returned to the patients by intraoperative blood salvage were high, the actual volumes returned depended on the case mix. There appears to be an opportunity to use blood salvage more selectively to improve efficiency.

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