A cost study of postoperative cell salvage in the setting of elective primary hip and knee arthroplasty.

The authors reviewed cell salvage data in a sample of 392 patients who underwent primary total hip (THA) or knee arthroplasty (TKA) and performed a detailed analysis, including sensitivity analysis, of costs associated with the use of an orthopedic perioperative autotransfusion device (OrthoPat, Haemonetics Corporation). Next, they extended this analysis to a theoretical scenario to calculate the costs associated with transfusing unwashed cells from wound drainage (device brand not stated), as well as that associated with transfusing the equivalent number of units of allogeneic blood.

Their analysis suggests that transfusing unwashed postoperatively salvaged cells is less costly than transfusing washed salvaged blood using the OrthoPat device or allogeneic blood in both THA and TKA. When compared to allogeneic transfusion, washed postoperatively salvaged cells carry a comparable cost in TKA but potentially represent significant savings in patients undergoing THA.

The authors recognize that interpreting the results of their cost comparison study requires several other considerations, including: indirect costs associated with allogeneic transfusion that were difficult to assign and quantify at their institution; clinicians’ adhesion to the local transfusion protocol based on hemoglobin thresholds and patient comorbidities; contribution of breakthrough transfusion (estimated to be around 35% in THA and 20% in TKA) to overall blood management costs; differences in pricing and procurement arrangements and options to outsource the OrthoPat service; etc.

From my point of view, there are two additional limitation that preclude a “real” cost comparison between the three transfusion modalities: 1) There is no a control group of patients managed with allogeneic blood only; 2) The amount of red cells lost during the washing procedure using the OrthoPaT (approx. 20%) was not been taken into account when the cost analysis was extended to the unwashed salvaged blood scenario.

Therefore, I do agree with the authors when they state that “prospective cost and outcomes analyses will be required to determine the optimal postoperative blood management modality from both a clinical and an economic standpoint”.

– Manuel Muñoz