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

Background: A 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. Methods: In 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. Results: Patient 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±1,600mL; 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±2.1g/dL; p=0.04), and hemoglobin at discharge was higher in the RBHS group (10.5±1.4 vs. 9.7±0.9g/dL; p=0.01). The estimated transfusion-related cost savings were $745/case by acquisition cost and approximately 3- to 5-fold this amount by activity-based cost. Conclusions: The use of RBHS in patients undergoing multilevel spine fusion surgery can conserve blood, promote higher hemoglobin levels, and reduce transfusion-related costs.