Abdominal Aortic Surgery: ICS vs Allogeneic Transfusion
The objective of this study was to assess the clinical and financial outcomes of intraoperative cell salvage (ICS) during abdominal aortic surgery. In this study, 90 patients were operated on with the use of ICS (group 1, prospective) and 90 patients without ICS (group 2, historical control). According to the type of operation, the patients were subdivided into three consecutive 30-patient subgroups (1, aortoiliac occlusive disease [AOD]; 2, elective abdominal aortic aneurysm [AAA]; or 3, ruptured abdominal aortic aneurysm [RAAA]). Transfusion requirements and postoperative complications were recorded. The total amounts of perioperatively transfused allogeneic blood were higher in all patient subgroups that underwent surgery without ICS (p = .0032). In the ICS group, 50% of AOD patients and 60% of elective AAA patients received no allogeneic transfusions. There were no significant differences in the incidence of postoperative complications in any group examined. ICS significantly reduced the necessity for allogeneic transfusions during abdominal aortic surgery. ICS use was most valuable in urgent situations with high blood losses, such as RAAA, for which only small amounts of allogeneic blood were initially available. In patients with more than 3 units of autologous blood reinfused, this method was cost effective.
Despite the fact that intraoperative cell salvage (ICS) has been in use for several decades as part of the autologous blood–preserving strategy, its clinical use remains controversial. There are three major concerns regarding the use of this technique: (1) Does ICS significantly reduce the need for allogeneic transfusions? (2) Is there a correlation between the use of ICS and a decrease in the incidence of perioperative complications? and (3) Does the use of ICS reduce overall transfusion costs? In addition to these concerns, it is a challenge to consistently provide sufficient allogeneic products for surgical procedures that possess the potential for significant blood loss. For example, cardiovascular surgical procedures can absorb up to 40% of total donor blood supply. Given the increasing costs of collecting and storing blood products and the decreasing number of voluntary blood donors, both in Serbia (only 3 donated blood units per 100 inhabitants) and worldwide, the demand for donated blood products can overwhelm even the best-organized transfusion services. Therefore, the use of ICS offers an alternative to the use of donated blood products.
Although often a lifesaving procedure, a number of risks are associated with allogeneic transfusion. Previous studies have concluded that approximately 20% of patients who have undergone an allogeneic transfusion will experience some deleterious side effects or complications that can compromise the clinical outcome of the patient, including infections, immunosuppression, and/or administrative errors. However, a substantial amount of conventional transfusion can also be associated with certain unwanted side effects, which include circulatory overloading, decreased platelet function, disseminated intravascular coagulation, and adult respiratory distress syndrome.
Given that abdominal aortic surgery is often associated with significant blood loss, it is an attractive procedure for ICS use. Nevertheless, controversial reports have been published about its utility. A systematic review by Alvarez and colleagues based on the meta-analysis of several randomized controlled trials concluded that insufficient evidence exists to recommend the use of ICS during elective abdominal aortic operations. In contrast to these results, Takagi and colleagues, in their recent meta-analysis of available randomized controlled trials, indicated that ICS reduced the risk of allogeneic transfusion in these procedures. Given that ICS has been used in a small number of clinics in Serbia since 1994 (our clinic has used this procedure since 2003), with many clinicians being unaware of its possibilities, we sought to evaluate the impact of this procedure on conventional transfusion requirements, the clinical outcome of treated patients, and the financial benefits of the use of this technology.
Abstract and Introduction
Abstract
The objective of this study was to assess the clinical and financial outcomes of intraoperative cell salvage (ICS) during abdominal aortic surgery. In this study, 90 patients were operated on with the use of ICS (group 1, prospective) and 90 patients without ICS (group 2, historical control). According to the type of operation, the patients were subdivided into three consecutive 30-patient subgroups (1, aortoiliac occlusive disease [AOD]; 2, elective abdominal aortic aneurysm [AAA]; or 3, ruptured abdominal aortic aneurysm [RAAA]). Transfusion requirements and postoperative complications were recorded. The total amounts of perioperatively transfused allogeneic blood were higher in all patient subgroups that underwent surgery without ICS (p = .0032). In the ICS group, 50% of AOD patients and 60% of elective AAA patients received no allogeneic transfusions. There were no significant differences in the incidence of postoperative complications in any group examined. ICS significantly reduced the necessity for allogeneic transfusions during abdominal aortic surgery. ICS use was most valuable in urgent situations with high blood losses, such as RAAA, for which only small amounts of allogeneic blood were initially available. In patients with more than 3 units of autologous blood reinfused, this method was cost effective.
Introduction
Despite the fact that intraoperative cell salvage (ICS) has been in use for several decades as part of the autologous blood–preserving strategy, its clinical use remains controversial. There are three major concerns regarding the use of this technique: (1) Does ICS significantly reduce the need for allogeneic transfusions? (2) Is there a correlation between the use of ICS and a decrease in the incidence of perioperative complications? and (3) Does the use of ICS reduce overall transfusion costs? In addition to these concerns, it is a challenge to consistently provide sufficient allogeneic products for surgical procedures that possess the potential for significant blood loss. For example, cardiovascular surgical procedures can absorb up to 40% of total donor blood supply. Given the increasing costs of collecting and storing blood products and the decreasing number of voluntary blood donors, both in Serbia (only 3 donated blood units per 100 inhabitants) and worldwide, the demand for donated blood products can overwhelm even the best-organized transfusion services. Therefore, the use of ICS offers an alternative to the use of donated blood products.
Although often a lifesaving procedure, a number of risks are associated with allogeneic transfusion. Previous studies have concluded that approximately 20% of patients who have undergone an allogeneic transfusion will experience some deleterious side effects or complications that can compromise the clinical outcome of the patient, including infections, immunosuppression, and/or administrative errors. However, a substantial amount of conventional transfusion can also be associated with certain unwanted side effects, which include circulatory overloading, decreased platelet function, disseminated intravascular coagulation, and adult respiratory distress syndrome.
Given that abdominal aortic surgery is often associated with significant blood loss, it is an attractive procedure for ICS use. Nevertheless, controversial reports have been published about its utility. A systematic review by Alvarez and colleagues based on the meta-analysis of several randomized controlled trials concluded that insufficient evidence exists to recommend the use of ICS during elective abdominal aortic operations. In contrast to these results, Takagi and colleagues, in their recent meta-analysis of available randomized controlled trials, indicated that ICS reduced the risk of allogeneic transfusion in these procedures. Given that ICS has been used in a small number of clinics in Serbia since 1994 (our clinic has used this procedure since 2003), with many clinicians being unaware of its possibilities, we sought to evaluate the impact of this procedure on conventional transfusion requirements, the clinical outcome of treated patients, and the financial benefits of the use of this technology.
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