3.6 Effect of perioperative strategies that minimise blood loss

3.6.10 Postoperative cell salvage

The detailed findings of the systematic review for this intervention can be found in Section 3.9.2 of Volume 1b of the technical report.4 The systematic review identified five Level I studies, of fair to good quality, and three Level II studies, of poor to fair quality relevant to postoperative cell salvage.

Transfusion requirements

A meta-analysis showed that the use of postoperative cell salvage resulted in a significant reduction in the incidence of transfusion in patients undergoing orthopaedic surgery, but not in patients undergoing cardiac surgery.191

In studies that used transfusion protocols, postoperative cell salvage resulted in a significant decrease in the incidence of transfusion compared to no cell salvage; however, there was no significant difference in studies where no transfusion protocol was used.

EVIDENCE STATEMENTS – postoperative cell salvage	Evidence	Consistency	Clinical impact	Generalisability	Applicability
In adult patients undergoing total knee arthroplasty, postoperative cell salvage reduces the incidence of allogeneic blood transfusion.
In adult patients undergoing cardiac surgery, postoperative cell salvage may reduce the incidence of allogeneic blood transfusion.			X
In adult patients undergoing cardiac surgery or total knee arthroplasty, postoperative cell salvage reduces the volume of allogeneic blood transfusion.
In adult patients undergoing cardiac surgery or total knee arthroplasty, postoperative cell salvage does not appear to have an effect on total blood loss.
In adult patients undergoing cardiac surgery, the effect of postoperative cell salvage on mortality is uncertain.			X
In adult patients undergoing cardiac surgery or total knee arthroplasty, postoperative cell salvage does not appear to have an effect on morbidity, including infection.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of postoperative cell salvage on quality of life is unknown.	NA	NA	NA	NA	NA
In adult patients undergoing total knee arthroplasty, the effect of postoperative cell salvage on haemoglobin concentration is uncertain.			X
In adult patients undergoing cardiac surgery, the effect of postoperative cell salvage on risk of reoperation for bleeding is uncertain.			X
In adult patients undergoing cardiac surgery and total knee arthroplasty, postoperative cell salvage may reduce length of hospital stay.

(See Table 2.2)

RECOMMENDATION – postoperative cell salvage

R20 Grade C	In adult patients undergoing cardiac surgery or total knee arthroplasty, in whom significant postoperative blood loss is anticipated, postoperative cell salvage should be considered (Grade C).