Efficacy of Intraoperative Cell Salvage on Perioperative Blood Transfusion in Pelvic and Acetabular Surgery: A Matched Cohort Analysis.

Background: Pelvic fractures often result in traumatic and intraoperative blood loss. Cell salvage (CS) is a tool where autologous blood lost during surgery is collected and recycled with anticoagulation, centrifugation to separate red blood cells, and washing to be reinfused back to the patient. The purpose of this study was to investigate our experience with CS in pelvic and acetabular surgery and its relationship to perioperative transfusion requirements.

Methods: After institutional review board approval, adult patients who underwent pelvic ring or acetabular open reduction internal fixation between 01/2014-11/2021 at a tertiary care level-one trauma center were retrospectively reviewed. Peri-operative outcomes including pre-/post-operative hemoglobin and hematocrit, estimated blood loss, use of CS, and perioperative blood transfusions were collected. Pooled two-sample t-tests were used to compare parametric populations while Fischer's exact test or Pearson's Chi squared test were used for nonparametric data.

Results: 402 patients were included (85 in the CS group and 317 in the non-CS group). Patients had a higher proportion of acetabular fractures. The use of CS was associated with longer operative time (366 mins vs. 269 mins, p<0.0001), EBL (911 mL vs. 473 mL, p<0.0001), and allogenic transfusion of RBC units intraoperatively (1.75 u vs. 1.28 u, p=0.0442) and postoperatively (1.38 u vs. 0.66 u, p<0.0012).

Conclusion: The use of CS was associated with higher total and postoperative allogenic units transfused. Future prospective randomized trials would help to further delineate the risks and benefits of CS utilization in surgical treatment of these fractures. Level of Evidence: III.