Effectiveness of intraoperative blood recovery in surgical patients at risk of transfusion: A rapid review.

BACKGROUND

Allogeneic blood transfusion is widely used to manage surgical blood loss but carries risks, such as infections and transfusion reactions, and is affected by blood shortages. Intraoperative blood recovery (cell salvage) may reduce the need for donor blood, improving patient safety and resource availability. This rapid review evaluated its clinical effectiveness, safety, and costs in surgical patients at risk of transfusion.

METHODS

Following the Cochrane rapid review guidelines, PubMed, the Virtual Health Library, and the Cochrane Library were searched for systematic reviews, randomized and non-randomized trials, and observational studies published between 2004 and October 2024. Eligible studies compared intraoperative blood recovery with allogeneic transfusion or no intervention in surgical patients. Outcomes included transfusion requirements, clinical safety, hospital indicators, and costs. Study quality was assessed using the AMSTAR-2 and Joanna Briggs Institute tools.

RESULTS

Fifty-two studies across multiple surgical specialties were included. Intraoperative blood recovery consistently reduced allogeneic transfusion requirements in orthopedic, obstetric, gastrointestinal, and pediatric cardiac surgeries. Evidence was mixed for cardiac, thoracic, and vascular surgeries. Safety profiles were favorable, with no significant adverse events directly attributed to intraoperative blood recovery. Some studies reported reductions in infection rates and hospital stay. Cost analyses (n = 16) yielded mixed results, with eight studies showing cost savings due to reduced transfusion needs.

CONCLUSION

Intraoperative blood recovery is effective and safe in reducing allogeneic transfusions, especially in high-blood-loss surgeries. Cost-effectiveness is context-dependent. Implementation should prioritize high-risk procedures and align with patient blood management strategies.