Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study

Journal of Orthopaedic Surgery and Research

Khaled M Kebaish²  Paul M Ness³  Ziya L Gokaslan⁴  Ian M Dwyer¹  Jack O Wasey¹  Steven M Frank⁵ 

[1] Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore 21287, MD, USA;Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore 21287, MD, USA;Department of Pathology, The Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore 21287, MD, USA;Department of Neurosurgery, Oncology, and Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore 21287, MD, USA;Patient Blood Management Program, Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Zayed 6208, 1800 Orleans Street, Baltimore 21287, MD, USA

关键词: Sealer;    Radiofrequency;    Hemostasis;    Cautery;    Blood;    Bipolar;   

Others  :  828579
DOI  :  10.1186/s13018-014-0050-2

 received in 2014-04-14, accepted in 2014-06-16,  发布年份 2014

【 摘 要 】

Background

A relatively new method of electrocautery, the radiofrequency bipolar hemostatic sealer (RBHS), uses saline-cooled delivery of energy, which seals blood vessels rather than burning them. We assessed the benefits of RBHS as a blood conservation strategy in adult patients undergoing multilevel spinal fusion surgery.

Methods

In a retrospective cohort study, we compared blood utilization in 36 patients undergoing multilevel spinal fusion surgery with RBHS (Aquamantys®, Medtronic, Minneapolis, MN, USA) to that of a historical control group (n = 38) matched for variables related to blood loss. Transfusion-related costs were calculated by two methods.

Results

Patient characteristics in the two groups were similar. Intraoperatively, blood loss was 55% less in the RBHS group than in the control group (810 ± 530 vs. 1,800 ± 1,600 mL; p = 0.002), and over the entire hospital stay, red cell utilization was 51% less (2.4 ± 3.4 vs. 4.9 ± 4.5 units/patient; p = 0.01) and plasma use was 56% less (1.1 ± 2.4 vs. 2.5 ± 3.4 units/patient; p = 0.03) in the RBHS group. Platelet use was 0.1 ± 0.5 and 0.3 ± 0.6 units/patient in the RBHS and control groups, respectively (p = 0.07). The perioperative decrease in hemoglobin was less in the RBHS group than in the control group (−2.0 ± 2.2 vs. –3.2 ± 2.1 g/dL; p = 0.04), and hemoglobin at discharge was higher in the RBHS group (10.5 ± 1.4 vs. 9.7 ± 0.9 g/dL; p = 0.01). The estimated transfusion-related cost savings were $745/case by acquisition cost and approximately 3- to 5-fold this amount by activity-based cost.

Conclusions

The use of RBHS in patients undergoing multilevel spine fusion surgery can conserve blood, promote higher hemoglobin levels, and reduce transfusion-related costs.

【 授权许可】

   
2014 Frank et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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