Summary of findings 8. Cell salvage compared to no cell salvage in orthopaedic (spinal) surgeries.
| Cell salvage compared to no cell salvage in orthopaedic (spinal) surgeries | ||||||
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Patient or population: orthopaedic (spinal) 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) | 558 per 1000 | 245 per 1000 (173 to 351) | RR 0.44 (0.31 to 0.63) | 194 (3 RCTs) | ⨁⨁⨁◯ Moderatea | Cell salvage probably reduces the risk of requiring allogeneic transfusion |
| Volume of transfusion (units) (PPT) (during hospital stay) | The mean volume of transfusion (units) (PPT) was 1.78 units | MD 0.59 higher (0.09 lower to 1.27 higher) | ‐ | 45 (1 RCT) | ⨁◯◯◯ Very lowb,c | Very low‐certainty evidence means we are uncertain whether cell salvage has an impact on the volume of transfusion required PPT |
| Mortality (up to 90 days) ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No data were available for this outcome |
| DVT (up to 90 days) ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | No data were available for this outcome |
| Infection (up to 90 days) | 0 per 1000 | 0 per 1000 (0 to 0) | RD 0.00 (‐0.06 to 0.06) | 63 (1 RCT) | ⨁⨁◯◯ Lowb,d | There may be no difference between cell salvage use and no cell salvage use for 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 a mixture of unclear and low risk across most domains, and high risk in more than half for blinding bDowngraded once for ROB, with a mixture of low and unclear risk across all domains except blinding, which were high risk cDowngraded twice for imprecision due to CI crossing both MID boundaries (MID calculated as +/‐0.5*SD in control group = +/‐0.5*1.05) dDowngraded once for imprecision as sample size is below OIS for this outcome