EARLY VERSUS LATE REPLACEMENT OF AUTOTRANSFUSED BLOOD IN ELECTIVE SPINAL SURGERY - A PROSPECTIVE RANDOMIZED STUDY

The use of autologous blood is a well established and extremely popular technique to decrease the necessity for homologous transfusions and the attendant risks of hepatitis, HIV, and HTLV-I/II infections, The most beneficial timing for autologous reinfusion of predonated blood remains unknown. The present study was undertaken to determine the optimal timing of autologous blood reinfusion in elective spinal surgery. Fifty-seven patients were prospectively individually randomly allocated into early versus delayed reinfusion groups prior to undergoing elective spinal surgery by a single surgeon. Three surgical subgroups were entered into the study: anterior/posterior (A/P) spinal fusion patients, posterior thoracolumbar scoliosis fusion patients (PSF), and degenerative posterior lumbar fusion patients (LF). Randomization was successful in that there was no significant difference in male to female ratio, age, preoperative hemoglobin, or number of units predonated between the early and delayed reinfusion groups. Likewise, there was no significant difference in the details of the operative procedure when compared as a group for the early versus delayed reinfusion groups. A significant increase in the postoperative day #1, 2 and 3 hemoglobin was seen in the early reinfusion group, while there was no significant difference seen in the postoperative day #7 hemoglobin between the early versus delayed reinfusion group. There was no effect of surgical grouping on these significant comparisons. Earlier patient mobilization was also seen in the early reinfusion groups for the A/P and PSF groups. There was no difference in patients' subjective evaluation of satisfaction and discomfort between the early or delayed reinfusion groups as determined by blinded interview on days 1, 3, 5, and 7 postoperatively. Only the PSF patients in the early reinfusion group reported significantly higher pain scores on postoperative day #3 which may correlate with their earlier ambulation (mean = 2.3 days). There was no difference in the nutritional parameters measured preoperatively or on postoperative day #7 between the early and delayed reinfusion groups, though all nutritional parameters were decreased on postoperative day #7 as is common in postoperative surgical patients. A significant increase was noted in the reticulocyte count obtained on postoperative day 7 in the early reinfusion patients. This study demonstrates beneficial effects of early (on the day of operation) reinfusion of predonated autologous blood. The prevention of early postoperative anemia and the potential for earlier ambulation suggest that earlier reinfusion of autologous blood is prudent. Furthermore, no detrimental effects of early autologous reinfusion were demonstrated. Further studies are needed to better determine the optimal hemoglobin level to which patients should be titrated after elective spinal surgery.