The impact of cell salvage on blood transfusion rates in major hepatobiliary surgery

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We believe that our work is of interest to the general surgical community as a whole, as it covers the topical issue of patient blood management in major abdominal surgery. In this retrospective cohort study we analyse the effect of cell salvage and intra-operative autologous blood transfusion on the outcome of 501 patients undergoing major hepatopancreatobiliary surgery. We find that use of cell salvage is associated with a significant reduction in absolute and average allogenic packed red cell transfusion and that both the use of cell salvage and correction of blood loss tolerance breach are independently associated with avoidance of transfusion. Our centre has developed a unique and highly specialised cell salvage service consisting of cell salvage practitioners whose sole task during surgery is to monitor blood loss, assess coagulopathy and return of blood aspirated from the operative field at regular intervals throughout surgery. This practice attempts to ensure that physiological levels of oxygen delivery are maintained throughout complex hepatobiliary procedures and we believe that the development of this practice is responsible for the significant avoidance in blood transfusion that we see in the cell salvage population presented here. The development of such a service is relatively unique to the UK and ours is, by some margin, the largest series to date analysing cell salvage use in hepatopancreatobiliary surgery. As such, despite its retrospective nature, this will be the highest level of published evidence demonstrating benefit of the routine use of cell salvage for major hepatopancreatobiliary resectional surgery.

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