Cell Salvage Transfusion Therapy for Open Reduction and Internal Fixation of Traumatic Pelvic and Acetabulum Fractures: An Analysis of Costs and Outcomes

Objectives: To evaluate the benefits of Cell Salvage (CS) therapy in patients with traumatic pelvis and/or acetabulum fractures. Design: Retrospective cohort study. Data collected from medical records and radiographs. Setting: Level-1 trauma center. Patients/Participants: 157 patients with traumatic pelvis and/or acetabulum fractures treated operatively under the care of one surgeon between 2008 and 2012 were included. Exclusion criteria included nonsurgical patients and those treated with percutaneous fixation. Intervention: All patients underwent open reduction internal fixation of their pelvis and/or acetabulum fractures. The use of cell salvage therapy was randomly selected for trauma patients based on the availability of the system. Main Outcome Measurements: Volume of allogeneic blood transfused (ABT), estimated blood loss (EBL), hemoglobin (Hb) levels preoperatively and postoperatively, and blood-related costs to the patient. Results: CS was used in 89 cases (56.7%) with an average volume of 86 mL. There was a significantly higher ABT in the CS group than the no CS group (625 vs. 376 mL, p < 0.05) however this difference disappeared when controlling for blood loss with the ABT/EBL ratio (1.08 vs. 0.74, p = 0.10). Cell saver showed some benefit in patients with high blood loss (> 500 mL) in which case there was a significantly higher volume of salvaged blood than patients with low blood loss (162 vs. 27 mL, p < 0.05), and in patients with > 7 days to surgery (135 vs. 64 mL, p < 0.05). The cost difference of $1,375 was seen between the two groups, favoring the No CS group. Conclusions: Our results suggest limited overall benefit to the use of CS in patients treated with ORIF for traumatic pelvis and acetabulum fractures. Journal of Nature and Science, 1(5):e99, 2015