Does Salvaged Blood Transfusion Reduce Allogenic Blood Use in Metastatic Spine Tumor Surgery?

Study design: Prospective cohort study. Objective: Evaluate the impact of salvaged blood transfusion use on allogenic blood transfusion requirement perioperatively. Summary of background data: Blood loss is an important consideration in metastatic spine tumor surgery (MSTS). Allogeneic blood transfusion (ABT) is the current standard of blood replenishment for MSTS despite known complications. Salvaged blood transfusion (SBT) through intraoperative cell salvage (IOCS) has shown to have similar outcomes as ABT and mitigates ABT risks. Methods: Patients who underwent MSTS from 2014 to 2017 were included. Patients were divided into three groups based on their BT type: no blood transfusion (NBT), ABT, and SBT. Patients were followed up for 4 years or till death, whichever was earlier. Results: Ninety-eight patients were included. In all, 33 patients received SBT, 39 received ABT and 26 received NBT. Median blood loss was 500 mL (ABT) versus 700 mL (SBT). Mean blood transfused was 600 mL for the ABT group and 705 mL for the SBT group. Median allogeneic transfusion volume was 600 mL (ABT) and 300 mL (SBT). Intraoperatively, the SBT group received a median of 350 mL of salvaged blood. Preoperative hemoglobin was similar across groups. Conclusion: SBT has shown to effectively reduce the amount of ABT required perioperatively for MSTS patients, on average saving up to 1 unit of blood per patient. This is the first long-term study in MSTS that directly analyzes the impact of SBT on ABT requirement, affirming its role in MSTS and patient blood management strategies. Level of evidence: Level II.