Perioperative Blood Management, Red Cell Recovery (Cell Salvage) Practice in an Australian Tertiary Hospital: A Hospital District Clinical Audit

BACKGROUND: Data on red cell recovery (cell salvage) utilization in Australia are limited and national guidance is based on a single Australian audit conducted at a hospital that excludes cardiothoracic surgery. This clinical audit aimed to analyze the utility of red cell recovery at a tertiary health care facility which includes cardiothoracic surgery. Secondary aims of this study were to identify specific surgical procedures in which red cell recovery is most beneficial and to quantify this benefit. METHODS: Data were collected retrospectively on all adult red cell recovery surgical cases conducted at a 2-campus health care facility over a 2-year period. Case demographic data, including surgical procedure, red blood cell return, and hematocrit levels, were collated and analyzed against national cell salvage guidelines. Average return per procedure was collated into a red cell recovery benefit analysis. RESULTS: A total of 471 red cell recovery cases for 85 surgical procedures met inclusion criteria. Of the 7 surgical subspecialties utilizing red cell recovery, orthopedics utilized the most cases (22.9%, n = 108), followed by urology (19.1%, n = 90) and cardiothoracic surgery (18.3%, n = 86). Radical retropubic prostatectomy (11.7%), revision (7.6%), and primary (6.6%) total hip replacement were the most utilized procedures. Red cell recovery use had a 79% compliance rate with national guidelines. Vascular surgery and urology had the highest average return at 699 mL (interquartile range, 351–1127; CI, 449–852) and 654 mL (interquartile range, 363–860; CI, 465–773), respectively. CONCLUSIONS: Overall, our center demonstrated good compliance with national red cell recovery guidelines. This audit adds to the existing data on red cell recovery practice in Australia and provides a benefit-specific surgical procedure guideline that includes cardiothoracic surgery. Accepted for publication May 5, 2018. Funding: None. The authors declare no conflicts of interest. Gold Coast Health Human Research Ethics Committee number: HREC/17/QGC/130. Reprints will not be available from the authors. Address correspondence to Elizabeth A. Forrest, MD, Department of Anaesthetics, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4214, Australia. Address e-mail to elizabeth.forrest3@health.qld.gov.au. © 2018 International Anesthesia Research Society

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