A cost study of post-operative cell salvage in the setting of elective primary hip and knee arthroplasty
Vidya K. Rao, Robert Dyga, Christopher Bartels, and Jonathan H. Waters*Hip Knee
Background
The rising costs, limited supply, and clinical risks associated with allogeneic blood transfusion have prompted investigation into autologous blood management strategies, such as post-operative red cell salvage. This study provides a cost comparison of transfusing washed post-operatively salvaged red cells using the OrthoPat device versus unwashed shed blood and banked allogeneic blood.
Study Design and Methods
Cell salvage data was retrospectively reviewed for a sample of 392 patients who underwent primary hip or knee arthroplasty. Average unit costs were calculated for washed salvaged red cells, equivalent units of unwashed shed blood, and therapeutically equivalent volumes of allogeneic packed red cells.
Results
No initial capital investment was required for the establishment of the post-operative cell salvage program. For patients undergoing total knee arthroplasty (TKA), the average unit cost for washed post-operatively salvaged cells, unwashed shed blood, and allogeneic banked blood was $758.80, $474.95, and $765.49, respectively. In patients undergoing total hip arthroplasty (THA), the average unit cost for washed post-operatively salvaged cells, unwashed shed blood, and allogeneic banked blood was $1827.41, $1167.41, and $2609.44, respectively.
Conclusion
This analysis suggests that transfusing washed post-operatively salvaged cells using the OrthoPat device is more costly than using unwashed shed blood in both THA and TKA. When compared to allogeneic transfusion, washed post-operatively salvaged cells carry a comparable cost in TKA, but potentially represent a significant savings in patients undergoing THA. Sensitivity analysis suggests that in the case of TKA, however, cost comparability exists within a narrow range of units collected and infused.
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