Is This Autograft Worth It?: The Blood Loss and Transfusion Rates Associated With Reamer Irrigator Aspirator Bone Graft Harvest

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To investigate the blood loss and transfusion rate associated with the use of reamer irrigator aspirator (RIA).


Retrospective review.


Academic Level-I trauma hospital.


One hundred eight patients requiring bone graft harvest for surgical reconstruction of nonunion or failed arthrodesis.


Bone graft harvest preformed via RIA or iliac crest bone graft (ICBG).

Main Outcome Measure:

Blood loss as measured by a change in preoperative and postoperative hematocrit (Hct). In addition, postoperative transfusion reported intraoperative blood loss, volume of graft harvested, and major complications.


The average Hct drop was found to be 13.7 (4.1–27.4) in the RIA cohort of 61 patients and 7.36 (1.2–14.5) in the ICBG cohort of 47 patients (P = 0.013). Operative reports documented an average estimated blood loss of 674 mL (100–2000 mL) in the RIA cohort compared with 255 mL (50–1000 mL) in the ICBG cohort (P < 0.001). Twenty-seven patients (44%) required blood transfusion after RIA, whereas 10 patients (21%) required blood transfusion after ICBG (odds ratio 5.32, 95% confidence interval 2.2–6.3, P < 0.001). RIA procedures collected an average 53 mL (20–100 mL) of bone graft compared with 27 mL (15–50 mL) with ICBG. There was no significant difference between groups regarding age, sex, medical comorbidities, or postoperative major complications.


This series demonstrated that 44% of patients undergoing RIA bone graft harvest required transfusion, with a mean Hct drop of 13.7 across all subjects, which is significantly greater than that associated with ICBG.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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