A Cost-Effectiveness Analysis Of Intraoperative Autologous Transfusion In Adolescent Idiopathic Scoliosis Surgery: A Single-center Retrospective Study

Abstract Background: Intraoperative autologous transfusion(IAT) has been used in scoliosis surgery for decades; however, its cost-effectiveness remains debatable. Therefore, this study aimed to evaluate the cost-effectiveness of IAT in adolescent idiopathic scoliosis (AIS) surgery with different blood loss volumes. Methods: The medical records of 402 patients who underwent AIS surgery were reviewed. Depending on the volume of blood lost during the operation, the patients were divided into three groups: A (≥500 to <1000 mL), B (≥1,000 to <1,500 mL), and C (≥1,500mL). Depending on whether IAT was used, each group was further divided into the IAT and no-IAT groups. The volume of blood loss, volume of transfused allogeneic red blood cells (RBC),and RBC transfusioncosts were analyzed.Univariate and multivariate logistic regression analyses were used to identify the independent risk factors of massive intraoperative blood loss (≥1,000 mL and ≥1,500 mL). A receiver operating characteristic (ROC) curve was used to analyze the cutoff values of the factors contributing to massive intraoperative blood loss. Results: In group B, the IAT group had a lower volume of allogeneic RBC transfused than the no-IAT group, whereas the total RBC transfusion cost in the IAT group was significantly higher than that in the no-IAT group. In group C, the volume of allogeneic RBC transfused in the IAT group reduced significantly more than that in the no-IAT group. The number of vertebral levels fused was found to be an independent risk factor for massive intraoperative blood loss. Conclusion: The cost-effectiveness of IAT in AIS is related to the volume of blood lost. The number of fused vertebral levels is an independent risk factor that can effectively predict massive intraoperative blood loss.