Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study

Steven M Frank, Jack O Wasey, Ian M Dwyer, Ziya L Gokaslan, Paul M Ness, Khaled M Kebaish

BackgroundA relatively new method of electrocautery, the radiofrequency bipolar hemostatic sealer (RBHS), uses saline-cooled delivery of energy, which seals blood vessels rather than burning them. We assessed the benefits of RBHS as a blood conservation strategy in adult patients undergoing multilevel spinal fusion surgery.MethodsIn a retrospective cohort study, we compared blood utilization in 36 patients undergoing multilevel spinal fusion surgery with RBHS (Aquamantys®, Medtronic, Minneapolis, MN, USA) to that of a historical control group (n¿=¿38) matched for variables related to blood loss. Transfusion-related costs were calculated by two methods.ResultsPatient characteristics in the two groups were similar. Intraoperatively, blood loss was 55 % less in the RBHS group than in the control group (810¿±¿530 vs. 1,800¿±¿1,600 mL; p¿=¿0.002), and over the entire hospital stay, red cell utilization was 51 % less (2.4¿±¿3.4 vs. 4.9¿±¿4.5 units/patient; p¿=¿0.01) and plasma use was 56 % less (1.1¿±¿2.4 vs. 2.5¿±¿3.4 units/patient; p¿=¿0.03) in the RBHS group. Platelet use was 0.1¿±¿0.5 and 0.3¿±¿0.6 units/patient in the RBHS and control groups, respectively (p¿=¿0.07). The perioperative decrease in hemoglobin was less in the RBHS group than in the control group (¿2.0¿±¿2.2 vs. ¿3.2¿±¿2.1 g/dL; p¿=¿0.04), and hemoglobin at discharge was higher in the RBHS group (10.5¿±¿1.4 vs. 9.7¿±¿0.9 g/dL; p¿=¿0.04). The estimated transfusion-related cost savings were $745/case by acquisition cost and approximately 3- to 5-fold this amount by activity-based cost.ConclusionsThe use of RBHS in patients undergoing multilevel spine fusion surgery can conserve blood, promote higher hemoglobin levels, and reduce transfusion-related costs.