The role of intra‐operative cell salvage in patient blood management for revision hip arthroplasty: a prospective cohort study

Cell salvage is an important component of blood management in patients undergoing revision hip arthroplasty surgery. However concerns regarding efficacy and patient selection remain. The aims of this study were to describe intra‐operative blood loss, cell salvage re‐infusion volumes and red blood cell transfusion rates for revision hip procedures and to identify factors associated with the ability to salvage sufficient blood intra‐operatively to permit processing and re‐infusion. Data were collected from a prospective cohort of 664 consecutive patients undergoing revision hip surgery at a single tertiary centre from 31 March 2015 to 1 April 2018. Indications for revision surgery were aseptic (n = 393 (59%)) fracture (n = 160 (24%)) and infection (n = 111 (17%)). Salvaged blood was processed and re‐infused when blood loss exceeded 500 ml. Mean (SD ) intra‐operative blood loss was 1038 (778) ml across all procedures. Salvaged blood was re‐infused in 505 of 664 (76%) patients. Mean (SD ) re‐infusion volume was 253 (169) ml. In total, 246 of 664 (37%) patients received an allogeneic red blood cell transfusion within 72 h of surgery. Patients undergoing femoral component revision only (OR (95%CI ) 0.41 (0.23–0.73)) or acetabular component revision only (0.53 (0.32–0.87)) were less likely to generate sufficient blood salvage volume for re‐infusion compared with revision of both components. Compared with aseptic indications, patients undergoing revision surgery for infection (1.87 (1.04–3.36)) or fracture (4.43 (2.30–8.55)) were more likely to generate sufficient blood salvage volume for re‐infusion. Our data suggest that cell salvage is efficacious in this population. Cases where the indication is infection or fracture and where both femoral and acetabular components are to be revised should be prioritised

The role of intraoperative cell salvage for musculoskeletal sarcoma surgery

Background:&nbsp;The efficacy and safety of cell salvage for musculoskeletal sarcoma surgery have not been reported, and concerns over re-infusion of tumour cells remain. This study aims to i) describe the intra-operative blood loss and cell salvage reinfusion volumes for lower limb sarcoma and pelvic sarcoma procedures ii) and explore whether there is evidence of tumour cells in reinfused blood. Methods:&nbsp;Retrospective analysis of 109 consecutive surgical procedures for biopsy-proven sarcoma or bone metastasis performed between 1 July 2015 and 30 October 2019. Salvaged blood was processed and reinfused when intraoperative blood loss exceeded 500&nbsp;ml. Primary bone tumour (n&nbsp;=&nbsp;86(79%)) and metastasis (n&nbsp;=&nbsp;23(21%) constituted the study group and surgeries were classified under hemipelvectomy (n&nbsp;=&nbsp;43(39%)), lower limb endoprosthesis replacement (LLE) (n&nbsp;=&nbsp;50(46%)) and wide excision surgery (WE) (n&nbsp;=&nbsp;16(15%)). Microscopic examination of imprint cytology of leuco-depletion(LD) filters, and peripheral smear examination was performed for reinfused blood. Results:&nbsp;Median (IQR) intra-operative blood loss was 1750 (600&ndash;3000) ml for hemipelvectomy, 850 (600&ndash;1200) ml for LLE, and 1000 (550&ndash;2000) ml for WE. Salvaged blood was re-infused in 102 of 109 (94%) patients. The mean (SD) volume of re-infusion was 445(4&nbsp;2&nbsp;5) ml for hemipelvectomy, 206(1&nbsp;3&nbsp;1) ml for LLE, and 184(1&nbsp;0&nbsp;6) ml for WE. In total, 64 of 109 (59%) patients received an allogeneic red blood transfusion within 72&nbsp;h of surgery. Cytology analysis of imprints taken from the filtered blood available in 95(87%) patients and peripheral smear examination of reinfused blood available in 32(29%) patients did not reveal evidence of tumour cells on microscopic examination of any samples. Conclusion:&nbsp;Our study demonstrates that musculoskeletal sarcoma surgery is associated with significant blood loss, and cell salvage permits reinfusion of autologous blood in most patients. The cytological analysis did not reveal evidence of tumour cells in reinfused blood, consistent with other studies where cell salvage is used for cancer surgery.</p

The BaBar detector

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