Impact of Cell Saver technology on pro-hemostatic factors transfusion in placenta accreta spectrum interventions: A 10-year retrospective single-center study.

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.