Background Intraoperative cell salvage is widely used in pediatric scoliosis surgery to reduce allogeneic transfusion requirements. However, its clinical effectiveness and economic impact remain uncertain. The objective of this study was to evaluate the efficacy and cost implications of intraoperative cell salvage in pediatric scoliosis surgery.

Methods A retrospective observational study was conducted, including 75 patients who underwent posterior instrumented spinal fusion between 2023 and 2025 at a tertiary referral center. Patients were stratified according to the use of intraoperative cell salvage. Demographic, perioperative, and postoperative variables were analyzed, including estimated blood loss, transfusion rates, hemoglobin levels, and length of stay. Subgroup analyses by reinfused blood volume, scoliosis etiology, and a propensity score-matched analysis were performed. A cost-benefit analysis and break-even evaluation were conducted from the hospital perspective.

Results Fifty-seven patients (76%) underwent surgery with cell salvage. No significant differences were observed in postoperative transfusion rates (22.8% vs 11.1 %; P = 0.32), hemoglobin levels, or length of stay. Patients with higher reinfused blood volumes had significantly greater estimated blood loss and higher postoperative transfusion rates (41.2% vs 15.0%; P = 0.04). No reduction in transfusion rates was observed across etiological subgroups. Propensity score matching confirmed the absence of benefit. The estimated cost per transfusion episode was €4754, while the cost of cell salvage was €250 per procedure. Cost neutrality would require avoiding 1 transfusion per 19 procedures, a threshold not achieved.

Conclusion Routine intraoperative cell salvage in pediatric scoliosis surgery was not associated with reduced transfusion rates or shorter hospital stays but increased health care costs. Its use should be considered selectively.