Efficacy and safety of intraoperative red blood cell salvage transfusion for spinal deformity surgery: a systematic review and meta-analysis.
Kush M Kale, Shaan Patel, Shiva A Nischal et al.
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In 30 seconds
This systematic review and meta-analysis pooled 22 observational studies of spinal deformity surgery, including 2,977 patients treated with intraoperative cell salvage (ICS) or without it. ICS was not associated with lower intraoperative or total perioperative transfusion volume, or a lower likelihood of receiving any perioperative transfusion. It was associated with a modest reduction in postoperative transfusion volume (SMD 0.25, 95% CI 0.04-0.46) and higher postoperative day 1 hemoglobin (MD -0.42 g/dL, 95% CI -0.76--0.07). Overall complications, costs, and length of stay did not differ significantly.
Key findings
- Across 22 observational studies, 2,977 patients were included: 1,851 received ICS and 1,126 were controls.
- ICS was not associated with reduced intraoperative transfusion volume (SMD 0.86, 95% CI -0.24-1.96) or total perioperative volume (SMD 1.15, 95% CI -0.75-3.05).
- ICS was associated with lower postoperative transfusion volume (SMD 0.25, 95% CI 0.04-0.46) and higher POD1 hemoglobin (MD -0.42 g/dL, 95% CI -0.76--0.07).
- No significant differences were observed in overall complications, transfusion-related costs, or length of hospital stay.
Why it matters
In spinal deformity surgery, ICS may support early postoperative erythrocyte reserve without reducing overall transfusion exposure. This distinction matters when weighing a blood-management intervention: improved postoperative measures do not necessarily translate into fewer patients transfused, lower total transfusion volume, or better reported clinical outcomes.
What to keep in mind
The evidence came from observational studies, so the comparisons cannot establish that ICS caused the observed differences.