Intraoperative cell salvage utilization for blood conservation during pediatric and adult spinal surgery: a state-of-the-art systematic review.

Purpose: The purpose of this systematic review was to identify the efficacy of cell salvage in adult and pediatric spinal surgery.

Methods: A comprehensive systematic review of four biomedical databases was conducted to identify study articles of interest. Articles from original studies were compiled for the composition of this manuscript. Spinal surgery is becoming increasingly common in both the United States and around the world. As such, spine surgeons typically make use of many methods to manage blood loss including intra-operative hypotension, use of crystalloid and colloid fluid resuscitation, anti-fibrinolytics, allogenic blood transfusions, and autologous transfusions. Allogenic blood is a common method to maintain blood volume throughout surgery but carries risks including transfusion reactions, immunosuppression, and transmission of viral blood-borne illnesses. Autologous blood products, like intra-operative cell saver or cell salvage (CS), offer a way to return the patient's own blood. However, CS remains controversial at this time. Some studies have found it to be efficacious in avoiding allogenic transfusion, while others have found that the results are no different in those who did not utilize CS. Some studies have even found that those who receive CS are more likely to require allogenic transfusions. This systematic review seeks to examine all the available literature on the use of CS in spinal surgery.

Conclusion: Currently, the role of CS is controversial in spinal surgery with studies reporting variable benefit. Many articles suggest that CS is only financially viable at higher volumes of blood loss and in more complex surgeries. Moreover, research regarding cost-effectiveness is lacking and is complicated by geographic factors. A multi-center large-scale randomized clinical trial could lead to the development of a model wherein the utility of CS could be assessed across a range of spinal surgeries, and could lead to the development of guidelines driving an individualized approach to the use of CS in spine surgery.