Intra-operative cell salvage in cardiac surgery may increase platelet transfusion requirements: A cohort study

Background and Objectives: The cell saver (CS) has been widely utilized in cardiac surgery to reduce red blood cell (RBC) transfusion. We aim at examining its effect on the rate of allogeneic transfusion, morbidity and mortality in our population. Materials and Methods: Retrospective review of all patients operated at the Sultan Qaboos University Hospital between 2008 and 2013 was performed. Patients' demographics, comorbidities and surgical details were retrieved. Study end-points included blood transfusion, infection, renal failure and mortality. Baseline characteristics of both groups were compared and differences were adjusted for in the multivariable logistic regression. Results: A total of 673 patients were included (CS = 395, non-CS = 278). Baseline characteristics were similar except for systemic hypertension, congestive heart failure and use of cardiopulmonary bypass. The CS group had higher transfusion rates of platelets (CS 36% vs. non-CS 18%; P < 0·001) and plasma (CS 31% vs. non-CS 19%; P < 0·001). After adjusting for baseline differences, CS use increased the odds of receiving platelet transfusion (odds ratio (OR) 3·2; P < 0·001) but not of plasma transfusion (OR 1·6; P = 0·087). There was no difference in the rate of RBC transfusion (CS 45% vs. non-CS 40%; P = 0·212), renal failure (CS 11% vs. non-CS 6%; P = 0·139), infection (CS 16% vs. non-CS 13%; P = 0·434) and mortality (CS 5% vs. non-CS 2%; P = 0·146). Conclusion: The CS use increases platelet requirements and has no impact on the rate of RBC transfusion in our population. These findings warrant caution with generalized use and require larger studies to confirm its results.