BACKGROUND: While Cell Saver technology effectively reduces red blood cell transfusion in the perioperative setting, its impact on the need for pro-hemostatic factors remains unclear. The use of Cell Saver could impact the requirements of pro-hemostatic factors. OBJECTIVE: This study assesses whether the use of Cell Saver influences transfusion requirements for fresh frozen plasma, platelet concentrates, and fibrinogen in surgeries for placenta accreta spectrum (PAS) disorders. METHODS: This retrospective, single-center, before-and-after study was conducted in a tertiary maternity hospital. Women undergoing surgery for PAS (cesarean delivery with conservative treatment or hysterectomy) were included. Two periods were compared: before (2013-2017, Period A) and after Cell Saver implementation (2019-2023, Period B), with a 1-year washout (2018). The primary outcome was a composite criterion: transfusion of ≥ 3 units of FFP (fresh frozen plasma) and/or ≥ 1 unit of PC (platelet concentrates) and/or ≥ 4 g fibrinogen. Univariate and multivariable logistic regression analyses were conducted, with subgroup analyses in women undergoing hysterectomy and those with blood loss ≥ 2000 mL. RESULTS: Among 136 women (69 in Period A, 67 in Period B), Cell Saver was used in 86% of Period B cases (median volume: 769 mL). The primary outcome occurred in 42% of Period A versus 52.2% of Period B (P = 0.23). However, multivariable analysis showed lower odds of pro-hemostatic transfusion with Cell Saver use (adjusted odds ratio 0.21; 95% confidence interval 0.06-0.77). In patients with ≥ 2000 mL blood loss, the primary outcome was significantly less frequent in Period B (71.1% vs. 95.6%, P < 0.05). CONCLUSION: Cell Saver use during PAS surgery is independently associated with reduced pro-hemostatic transfusion, especially in cases with major bleeding, supporting its routine use.
Levy et al. (Thu,) studied this question.
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