Randomized trial of Cell Saver in 2- to 3-level lumbar instrumented posterior fusions

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The goal of this study was to determine efficacy and cost-effectiveness of Cell Saver in 2- and 3-level lumbar decompression and fusion.


Patients seen at a tertiary care spine center who were undergoing a posterior 2- or 3-level lumbar decompression and fusion were randomized to have Cell Saver used during their surgery (CS group, n = 48) or not used (No Cell Saver [NCS] group, n = 47). Data regarding preoperative and postoperative hemoglobin and hematocrit, estimated blood loss, volume of Cell Saver blood reinfused, number of units and volume of allogeneic blood transfused intraoperatively and postoperatively, complications, and costs were collected. Costs associated with Cell Saver use were calculated based on units of allogeneic blood transfusions averted.


Demographics and surgical parameters were similar in both groups. The mean estimated blood loss was similar in both groups: 612 ml in the CS group and 742 ml in the NCS group. There were 53 U of allogeneic blood transfused in 29 patients in the NCS group at a total blood product cost of $67,688; and 38 U of allogeneic blood transfused in 16 patients in the CS group at a total blood cost of $113,162, resulting in a cost of $3031 per allogeneic blood transfusion averted using Cell Saver.


Cell Saver use produced lower rates of allogeneic transfusion but was found to be more expensive than using only allogeneic blood for 2- and 3-level lumbar degenerative fusions. This increased cost may be reasonable to patients who perceive that the risks associated with allogeneic transfusions are unacceptable.

CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized controlled trial; evidence: class III.

ABBREVIATIONS ASA = American Society of Anesthesiologists; BMI = body mass index; CS = Cell Saver; NCS = No Cell Saver; RCT = randomized controlled trial.

Article Information

Correspondence Leah Y. Carreon: Norton Leatherman Spine Center, Louisville, KY. leah.carreon@nortonhealthcare.org.

INCLUDE WHEN CITING Published online August 17, 2018; DOI: 10.3171/2018.4.SPINE18116.

Disclosures Dr. Carreon is an employee of Norton Healthcare, a consultant for AO Spine, and has received funds for travel from the University of Southern Denmark and the University of Louisville. She has received research funds from OREF, Norton Healthcare, Scoliosis Research Society (SRS), Pfizer, Integra, and IntelliRod (paid to her institution). She is a member of the Editorial Advisory Board for Spine, Spine Journal, and Spine Deformity; of the University of Louisville IRB; and of the Research Committee SRS. NuVasive provided funds directly to the database company. No funds are paid directly to the individual or the individual’s institution. Dr. Crawford is a consultant for NuVasive and Medtronic, and he is an employee of Norton Healthcare. He receives clinical or research support for the study described (includes equipment or material) from Norton Healthcare. Dr. Dimar is a consultant for Medtronic and DePuy. He receives royalties from Medtronic. He is a board member of SRS and the Federation of Spine Associations, and he reviews for the Journal of the American Academy of Orthopedic Surgeons, Spine Deformity, Spine, and Global Spine. Dr. Djurasovic is a consultant for Medtronic and NuVasive. Dr. Glassman is an employee of Norton Healthcare. He holds a patent with Medtronic, as well as being a consultant and receiving royalties from that company. He is a past president of the SRS. Dr. Owens is a consultant for NuVasive and Medtronic.

© AANS, except where prohibited by US copyright law.



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