A Prospective Study On Intraoperative Autotransfusion For Spondylolisthesis

Objective:The operations for spondylolisthesis frequently are associated with substantial perioperative and postoperative blood loss, consequently, postoperative blood transfusions are common. There is no clear consensus regarding the changes of postoperative hemoglobin level, hematocrit and total blood loss after the intraoperative blood salvage was retransfused. We conduct a study about the effects of retransfused intraoperative blood salvage on hemoglobin level, hematocrit, total blood loss and the postoperative requirements for ABTs.Methods:We conducted a prospective, controlled, randomized study about 80 patients underwent spinal posterior laminectomy and instrumented fusion for spondylolisthesis from August 2012 to August 2013. In Group A (n=40 patients), the intraoperative autotransfusion system was used intraoperatively. In group B (n=40 patients), a regular drain without intraoperative autotransfusion system was used. The blood collection and surgery started simultaneously. During the operation, we filtered, centrifuged, washed and removed the tissue particles, blood clot, broken red blood cells, plasma and anticoagulant of the collected blood at room temperature, then, retransfused the blood in 6 hours. The preoperative demographic data (age, weight, sex), primary diagnosis, postoperative (1,3,5,7 days) hemoglobin level and hematocrit, total blood loss and postoperative requirements for ABTs were compared in our study.Results:There were no statistical difference in age, weight, sex, initial diagnosis. In group A, the mean hemoglobin level of the retransfused blood was 82.71±19.17 g/L, and the mean hematocrit was 24.51±8.23%. There were no statistical differences in preoperative hemoglobin levels (p=0.48) and hematocrit (p=0.271) between two groups. The postoperative hemoglobin levels and hematocrit were higher in group A than group B (p >0.05). All of the values decreased in the postoperative first three days, and then showed an gradually increasing trend. The pre-and post-operative (1,3,5,7 days) reduction of hemoglobin level and hematocrit were higher in group B than group A (p<0.05). The total blood loss in group A was less than group B(1015.03±682.42ml VS 1278.66±543.10ml P=0.252).2 patients(5%) received ABTs(3u/person) in group A,3 patients(7.5%) received ABTs(3.5u/person) in group B(p=0.644). None of the patients suffered from fever, rash, infection.Conclusions:In the operations for spondylolisthesis, the intraoperative autotransfusion system can neither significantly increase the postoperative hemoglobin and hematocrit nor decrease the total blood loss and the requirement for ABTs. But it can significantly decrease the degree of reduction in postoperative hemoglobin and hematocrit. During the operations, the intraoperative autotransfusion system is a safe and effective method for the patients who combined with preoperative low-hemoglobin, other underlying diseases or anticipated substantial blood loss, while the postoperative hemoglobin and hematocrit should be monitored in case of the symptom of anemia or hypoproteinemia.