Torakal ve lomber vertebra k�r�klar�nda enstr�mentasyon ve posterior f�zyon uygulanm�� hastalarda maliyet ve h�cre koruyucu sistemin etkinli�i

Ba�aran, Serdar Hakan; Bayrak, Alkan; Sayit, Emrah; �ne�, Halil Nadir; G�z�g�l, Kadir; Kural, Cemal

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Torakal ve lomber vertebra k�r�klar�nda enstr�mentasyon ve posterior f�zyon uygulanm�� hastalarda maliyet ve h�cre koruyucu sistemin etkinli�i [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2019; 25(1): 66-70 | DOI: 10.5505/tjtes.2018.77823

Torakal ve lomber vertebra k�r�klar�nda enstr�mentasyon ve posterior f�zyon uygulanm�� hastalarda maliyet ve h�cre koruyucu sistemin etkinli�i

Serdar Hakan Ba�aran¹, Alkan Bayrak¹, Emrah Sayit², Halil Nadir �ne�¹, Kadir G�z�g�l³, Cemal Kural¹
¹Bak�rk�y Dr. Sadi Konuk E�itim ve Ara�t�rma Hastanei, Ortopedi ve Travmatoloji Klini�i, �stanbul
²Samsun E�itim ve Ara�t�rma Hastanesi, Ortopedi ve Travmatoloji Klini�i, Samsun
³�stanbul �niversitesi Cerrahpa�a T�p Fak�ltesi, Ortopedi ve Travmatoloji Anabilim Dal�, �stanbul

AMA�: �al��mam�z�n amac� torakal ve lomber vertebra k�r�klar� nedeniyle posterior enstr�mantasyon ve f�zyon yap�lan ve ameliyatta ototransf�zyon yap�lan hastalarda h�cre koruyucu sistemin etkinli�ini ve maliyet etkinli�ini belirlemektir.
GERE� VE Y�NTEM: Torakal ve lomber vertebra k�r�klar� nedeniyle posteriyor enstr�mentasyon ve f�zyon uygulanm�� 121 hasta iki guruba ayr�ld�: 59 hasta (23 erkek ve 36 kad�n) h�cre koruyucu gurup, 62 hasta (22 erkek ve 40 kad�n) kontrol gurubuna dahil edildi. Hastalar�n hemoglobin, hemotokrit ve k�rm�z� h�cre say�s� (KHS) ameliyat �ncesi ve sonras� birinci, ikinci, ��nc� g�n ve taburculuk esnas�ndaki de�erleri de�erlendirildi. Transf�zyon oranlar� ve allojenik eritrosit transf�zyonlar�n�n (AET�ler) yan� s�ra, transf�zyona tabi tutulan toplam oto ve allojenik transf�zyonlar�n maliyetleri kar��la�t�r�ld�.
BULGULAR: Perioperatif kan transf�zyonu h�cre koruyucu grupta 0.2�0.6 �nite, kontrol grubunda 0.7�1.4 �nite olarak tespit edildi (p=0.01). Ameliyat sonras� birinci, ikinci ve ��nc� g�nde hemoglobin, hemotokrit ve KHS aras�nda istatistiksel olarak anlaml� fark tespit edildi. Taburculuk hemoglobin, hemotokrit ve KHS aras�nda anlaml� farkl�l�k saptanmad�. Perioperatif kan transf�zyonu ortalama maliyeti h�cre koruyucu grupta $431�27.4, kontrol grubunda $34.5�66.25 olarak belirlendi (p<0.001).
TARTI�MA: H�cre koruma sisteminin kullan�m� maliyet a��s�ndan uygun de�ildi, ancak �zellikle ameliyat sonras� allojenik kan transf�zyonlar�n�n oran�n� ve say�s�n� azaltmada ba�ar�l�yd�.

Anahtar Kelimeler: H�cre koruyucu sistem, kan transf�zyonu; maliyet etkinli�i; omurga cerrahisi.

Efficacy and cost-effectiveness of the cell saver system in instrumented posterior fusion with thoracic and lumbar vertebral fractures

Serdar Hakan Ba�aran¹, Alkan Bayrak¹, Emrah Sayit², Halil Nadir �ne�¹, Kadir G�z�g�l³, Cemal Kural¹
¹Department of Orthopaedics and Traumatology, Bak�rk�y Dr. Sadi Konuk Training and Research Hospital, �stanbul-Turkey
²Department of Orthopaedics and Traumatology, Samsun Training and Research Hospital, Samsun-Turkey
³Department of Orthopaedics and Traumatology, Istanbul University Cerrahpa�a Faculty of Medicine, �stanbul-Turkey

BACKGROUND: The aim of our study was to determine the efficacy and cost-effectiveness of intraoperative autotransfusion that uses the cell saver system (CSS) in patients undergoing posterior instrumentation and fusion of thoracic and lumbar vertebral fractures.
METHODS: We divided 121 patients who were to undergo posterior instrumentation and fusion due to thoracic and lumbar vertebral fractures into two groups: 59 patients (23 males and 36 females) were in the cell saver group, and 62 patients (22 males and 40 females) were in the control group. Hemoglobin, hematocrit, and red blood cell (RBC) values were recorded for all patients preoperatively, on the postoperative first, second, and third days, and on the hospital discharge day. Transfusion rates and numbers of allogeneic erythrocyte transfusions, as well as the costs of transfused total auto- and allogeneic transfusions were compared.
RESULTS: The numbers of erythrocyte suspensions transfused perioperatively were 0.2�0.6 units in the cell saver group and 0.7�1.4 units in the control group (p=0.01). Statistically significant differences were noted between the two groups on the postoperative first, second, and third days in terms of hemoglobin, hematocrit, and RBC values. These differences had disappeared by the hospital discharge day. The average cost of perioperative blood transfusions was $431�27.4 in the cell saver group and $34.5�66.25 in the control group (p<0.001).
CONCLUSION: The use of the CSS was not cost-effective, but it was particularly successful at reducing the rate and the number of units of postoperative allogenic blood transfusions.

Keywords: Blood transfusion, cell saver system; cost effectiveness; spinal surgery.

Sorumlu Yazar: Serdar Hakan Ba�aran, T�rkiye
Makale Dili: �ngilizce

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