Summary of findings 1. Cell salvage compared to no cell salvage in cancer surgery.
| Cell salvage compared to no cell salvage in cancer surgery | ||||||
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Patient or population: cancer surgery Setting: hospital Intervention: cell salvage Comparison: no cell salvage | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no cell salvage | Risk with cell salvage | |||||
| Transfusions (during hospital stay) ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No data were available for this outcome |
| Volume (PPT) (during hospital stay) ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No data were available for this outcome |
| Mortality (up to 90 days) | 98 per 1000 | 55 per 1000 (11 to 273) | RR 0.56 (0.11 to 2.80) | 79 (2 RCTs) | ⨁◯◯◯ Very lowa,b | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on mortality risk |
| DVT (up to 90 days) | 167 per 1000 | 83 per 1000 (8 to 802) | RR 0.50 (0.05 to 4.81) | 24 (1 RCT) | ⨁◯◯◯ Very lowb,c | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on DVT risk |
| Infection (up to 90 days) | 448 per 1000 | 345 per 1000 (179 to 672) | RR 0.77 (0.40 to 1.50) | 55 (1 RCT) | ⨁◯◯◯ Very lowa,d | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on infection risk |
| MI (up to 90 days) ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No data were available for this outcome |
| CVA (stroke) (up to 90 days) ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No data were available for this outcome |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; CVA: cerebrovascular accident; DVT: deep vein thrombosis; MD: mean difference; MI: myocardial infarction; MID: minimally important difference; OIS: optimal information size; POR: Peto odds ratio; PPT: per person transfused; RD: risk difference; ROB: risk of bias; RR: risk ratio; SD: standard deviation | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded once for ROB due to judgement of unclear or low risk in all domains (mostly unclear) bDowngraded three times for imprecision: very wide confidence intervals (crosses both boundaries for MID: 0.8 to 1.25), and OIS is far below that needed for rare events cDowngraded twice for ROB due to judgement of unclear and high ROB in all domains dDowngraded twice for imprecision: wide confidence intervals (crosses both boundaries for MID: 0.8 to 1.25)