Antifibrinolytics Reduce Blood Loss in Adult Spinal Deformity Surgery

Peters, Austin; Verma, Kushagra; Slobodyanyuk, Kseniya; Cheriyan, Thomas; Hoelscher, Christian; Schwab, Frank J.; Lonner, Baron; Huncke, Tessa; Lafage, Virginie; Errico, Thomas J.

doi:10.1097/brs.0000000000000799

Cited by 87 publications

(43 citation statements)

References 20 publications

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“…These inconsistent results may warrant more number of future refined studies, despite most high level of evidence studies favor the use of TXA in spinal surgery5,24,25). Most studies showed tendency toward less postoperative bleeding in TXA group with or without statistical significance1,20,24,25). Present study also demonstrated less postoperative drain amount in TXA group without reaching statistical significance.…”

Section: Discussionmentioning

confidence: 60%

“…Previous investigator did not find any significant differences in intraoperative blood losses or transfusion requirements between TXA and control groups in patients with spinal deformity17,20). Baldus and colleagues concluded in their study in patients undergoing lumbar pedicle subtraction osteotomy that TXA use did not decrease surgical bleeding or intraoperative transfusion amount whereas using aprotinin did1).…”

Section: Discussionmentioning

confidence: 94%

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Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

Choi

Hyun

Kim

et al. 2017

J Korean Neurosurg Soc

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ObjectiveSpinal deformity surgery has the potential risk of massive blood loss. To reduce surgical bleeding, the use of tranexamic acid (TXA) became popular in spinal surgery, recently. The purpose of this study was to determine the effectiveness of intra-operative TXA use to reduce surgical bleeding and transfusion requirements in spinal deformity surgery.MethodsA total of 132 consecutive patients undergoing multi-level posterior spinal segmental instrumented fusion (≥5 levels) were analyzed retrospectively. Primary outcome measures included intraoperative estimated blood loss (EBL), transfusion amount and rate of transfusion. Secondary outcome measures included postoperative transfusion amount, rate of transfusion, and complications associated with TXA or allogeneic blood transfusions.ResultsThe number of patients was 89 in TXA group and 43 in non-TXA group. There were no significant differences in demographic or surgical traits between the groups except hypertension. The EBL was significantly lower in TXA group than non-TXA group (841 vs. 1336 mL, p=0.002). TXA group also showed less intra-operative and postoperative transfusion requirements (544 vs. 812 mL, p=0.012; 193 vs. 359 mL, p=0.034). Based on multiple regression analysis, TXA use could reduce surgical bleeding by 371 mL (37 % of mean EBL). Complication rate was not different between the groups.ConclusionTXA use can effectively reduce the amount of intra-operative bleeding and transfusion requirements in spinal deformity surgery. Future randomized controlled study could confirm the routine use of TXA in major spinal surgery.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 94%

Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

Choi

Hyun

Kim

et al. 2017

J Korean Neurosurg Soc

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“…Multiple studies have demonstrated the potential effectiveness of intraoperative antifibrinolytic therapy in significantly reducing blood loss (A. Soroceanu et al, unpublished data). 9,36,65 In addition, a recently published application of rotational thromboelastometry-guided blood product management to major spine procedures suggests that this technology may aid in reducing blood loss, blood product use, and cost. 31 Infections accounted for 9% of all major complications, and deep wound infection was the most common infection.…”

Section: Discussionmentioning

confidence: 99%

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Smith

Klineberg

Lafage

et al. 2016

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178

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OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82 patients (28.2%). A total of 270 perioperative complications (145 minor; 125 major) were reported, with 152 patients (52.2%) affected, and a total of 199 delayed complications (62 minor; 137 major) were reported, with 124 patients (42.6%) affected. Overall, 469 complications (207 minor; 262 major) were documented, with 203 patients (69.8%) affected. The most common complication categories included implant related, radiographic, neurological, operative, cardiopulmonary, and infection. Higher complication rates were associated with older age (p = 0.009), greater body mass index (p ≤ 0.031), increased comorbidities (p ≤ 0.007), previous spine fusion (p = 0.029), and 3-column osteotomies (p = 0.036). Cases in which 2-year follow-up was not achieved included 2 perioperative mortalities (pulmonary embolus and inferior vena cava injury). CONCLUSIONS This study provides an assessment of complications associated with ASD surgery based on a prospective, multicenter design and with a minimum 2-year follow-up. Although the overall complication rates were high, in interpreting these findings, it is important to recognize that not all complications are equally impactful. This study represents one of the most complete and detailed reports of perioperative and delayed complications associated with ASD surgery to date. These findings may prove useful for treatment planning, patient counseling, benchmarking of complication rates, and efforts to improve the safety and cost-effectiveness of patient care.

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“…Blood loss during ASD surgery may be greater than 4 L in cases involving osteotomy, 7 potentially leading to organ damage, coagulopathy, infections, longer hospital stays, and higher costs. 16 Recently, a double-blinded randomized controlled trial showed that antifibrinolytics significantly reduced blood loss in posterior ASD surgery compared with placebo. 16 Not surprisingly, coagulopathy was the strongest independent factor associated with development of any postoperative complication (OR 4.2).…”

Section: Discussionmentioning

confidence: 99%

“…16 Recently, a double-blinded randomized controlled trial showed that antifibrinolytics significantly reduced blood loss in posterior ASD surgery compared with placebo. 16 Not surprisingly, coagulopathy was the strongest independent factor associated with development of any postoperative complication (OR 4.2). This was followed by revision procedures (also associated with higher blood loss) 23 and complex procedures.…”

Section: Discussionmentioning

confidence: 99%

Inpatient morbidity and mortality after adult spinal deformity surgery in teaching versus nonteaching hospitals

Ramos¹,

Jain

Kebaish

et al. 2016

SPI

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OBJECTIVE The goal of this study was to compare inpatient morbidity and mortality after adult spinal deformity (ASD) surgery in teaching versus nonteaching hospitals in the US. METHODS The Nationwide Inpatient Sample was used to identify surgical patients with ASD between 2002 and 2011. Only patients > 21 years old and elective cases were included. Patient characteristics, inpatient morbidity, and inpatient mortality were compared between teaching and nonteaching hospitals. A multivariable logistic regression analysis was performed to examine the effect of hospital teaching status on surgical outcomes. RESULTS A total of 7603 patients were identified, with 61.2% (n = 4650) in the teaching hospital group and 38.8% (n = 2953) in the nonteaching hospital group. The proportion of patients undergoing revision procedures was significantly different between groups (5.2% in teaching hospitals vs 3.9% in nonteaching hospitals, p = 0.008). Likewise, complex procedures (defined as fusion of 8 or more segments and/or osteotomy) were more common in teaching hospitals (27.3% vs 21.7%, p < 0.001). Crude overall complication rates were similar in teaching hospitals (47.9%) compared with nonteaching hospitals (49.8%, p = 0.114). After controlling for patient characteristics, case complexity, and revision status, patients treated at teaching hospitals were significantly less likely to develop a complication when compared with patients treated at a nonteaching hospital (OR 0.89; 95% CI 0.82–0.98). The mortality rate was 0.4% in teaching hospitals and < 0.4% in nonteaching hospitals (p = 0.210). CONCLUSIONS Patients who undergo surgery for ASD at a teaching hospital may have significantly lower odds of complication development compared with patients treated at a nonteaching hospital.

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Antifibrinolytics Reduce Blood Loss in Adult Spinal Deformity Surgery

Abstract: 1.

Cited by 87 publications

References 20 publications

Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Inpatient morbidity and mortality after adult spinal deformity surgery in teaching versus nonteaching hospitals

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