The impact of intra-operative cell salvage during open nephrectomy

Abstract Objective To assess the impact of intra-operative cell salvage on outcomes in open nephrectomy. Methods A retrospective cohort study was performed of all patients undergoing open nephrectomy for suspected malignancy from 1 October 2013 to 1 October 2017. Patients were grouped and compared based on whether they received intra-operative cell salvage (ICS). Primary outcomes were allogeneic transfusion rates (ATRs), and if histology confirmed cancer, disease recurrence. Secondary outcomes were complications and transfusion-related cost. Results Forty patients underwent open nephrectomy for suspected malignancy during the enrolment period. Sixteen patients received ICS while 24 did not (standard group). Compared with the standard group, ICS patients had similar median age (63.5 vs. 61.0 years; p  = 0.83) but fewer females (19% vs. 58%; p  = 0.013). The groups were similar in pre-operative and discharge haemoglobin, Charlson Comorbidity Index, length of hospital stay and proportion with thoracoabdominal surgical approach. The ICS group had a smaller proportion undergoing partial nephrectomy (19% vs. 54%; p  = 0.025) and shorter median follow-up (278 vs. 827 days; p  = 0.0005). Histology was malignant for 14 ICS and 15 standard patients. The ICS group had more frequent ≥ T2 disease (79% vs. 27%; p  = 0.005). There were no positive margins. Both groups had similar ATRs (6% vs. 4%; p  = 0.96), complication rates (19% vs. 29%; p  = 0.46) and recurrence rates (18% vs. 7%; p  = 0.40). Transfusion costs were higher amongst ICS patients (AUD $878.18 vs. $49.65 per patient). Conclusion ICS appears safe, with low rates of recurrence and complication. Both groups had low ATRs, and therefore cost benefit for ICS was not seen.