P10 Transfusion-Related Cost of Aprotinin in Scoliosis Surgery for Children and Adolescents.

Introduction  Scoliosis surgery causes major blood loss. Previous research has demonstrated that aprotinin reduces perioperative blood loss and thus transfusion. To date there has not been a cost analysis of the effect of aprotinin on transfusion requirement in scoliosis surgery. Methods  Retrospective case series of all patients <18 years old at the time of their scoliosis surgery. All patients were operated on and anaesthetised by the same consultant surgeon and anaesthetist between May 2002 and February 2006. Estimated blood volume (EBV) was 70 mL kg−1. Postoperative care was on the Paediatric Intensive Care Unit (PICU) or Spinal High Dependency Unit (HDU). The anaesthetic chart and cell salvage audit form recorded intra-operative blood loss. The PICU/HDU charts recorded postoperative drain blood loss for the first 24 h. Aprotinin was given as a bolus prior to the start of surgery followed by an infusion until wound closure. Cost data for allogeneic blood products, autologous blood collection/processing and aprotinin were collected from the start of surgery until 24 h postoperatively. The analysis used current tariffs. Other consumables and drugs were excluded. Comparisons between groups were made using unpaired t tests. Results  A total of 27 patients were reviewed. Fifteen patients received aprotinin and 12 did not. Intra-operative cell salvage was used for all patients. Two thirds of the patients in each group were at high risk of major blood loss due to neuro-muscular disease. The groups (aprotinin versus no aprotinin) were comparable for age (mean ± SD) 13 ± 2.8 versus 14 ± 2.7 years, weight 50.9 ± 16.9 versus 51.2 ± 30.4 kg, surgical time 254 ± 58.8 versus 286 ± 109.6 min and vertebral levels fused (median + interquartile range) 15 (10–16) versus 14.5 (8.5–16). Mean aprotinin bolus dose was 21.14 ± 10.91 kiU kg−1 and mean aprotinin infusion rate was 7.17 ± 2.44 kiU kg−1 h−1. The median transfusion-related cost of aprotinin was £638.02 (£319.73–£1010.60) compared to £1086.00 (£423.42–£1476.01)(P = 0.107) without aprotinin, equating to a relative cost saving of 41.2%. Total peri-operative blood loss (as a fraction of EBV), in the aprotinin group was 0.66 ± 0.40 EBV versus 1.25 ± 1.06 EBV(P = 0.09). Median units of blood product transfused in the aprotinin and no aprotinin groups were; blood 1 ( 0–2.5) versus 2.5 (1–5.25) (P = 0.06), fresh frozen plasma 2 (1–2.5) versus 2 (2.3–3.25) (P = 0.07), cryoprecipitate bags 0 (0–0) versus 0 (0–2) (P = 0.16), platelets 0 (nil given) versus 0 (0–1) (P = 0.07). Conclusions  The reduction in peri-operative blood loss and thus transfusion requirements associated with aprotinin has translated to a cost reduction. A small sample size has prevented the cost analysis from reaching statistical significance. As blood products become more scarce and costly, blood preservation techniques will become increasingly vital.