Association between preoperative hemoglobin levels after iron supplementation and perioperative blood transfusion requirements in children undergoing scoliosis surgery

Switzer, Timothy; Naraine, Nadia; Chamlati, Racha; Lau, Wendy; McVey, Mark J.; Zaarour, Christian; Faraoni, David

doi:10.1111/pan.13987

Cited by 14 publications

(6 citation statements)

References 22 publications

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“…Two studies suggest that higher preoperative hemoglobin levels as a result of iron supplementation lead to the need for fewer transfusions in pediatric patients undergoing posterior spinal fusion. 45,46 Typical regimens include 325 mg (65 mg elemental iron) of ferrous nitrate twice per day for 4 weeks preoperatively. Preoperative erythropoietin has also been studied as a blood conservation strategy.…”

Section: Error Trap 3: Failure To Prevent Excessive Bleeding Decrease...mentioning

confidence: 99%

Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery

Hammon,

Chidambaran,

Templeton

et al. 2023

Pediatric Anesthesia

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Anesthesia for posterior spinal fusion for adolescent idiopathic scoliosis remains one of the most common surgeries performed in adolescents. These procedures have the potential for significant intraprocedural and postoperative complications. The potential for pressure injuries related to prone positioning must be understood and addressed. Additionally, neuromonitoring remains a mainstay for patient care in order to adequately assess patient neurologic integrity and alert the providers to a reversible action. As such, causes of neuromonitoring signal loss must be well understood, and the provider should have a systematic approach to signal loss. Further, anesthetic design must facilitate intraoperative wake‐up to allow for a definitive assessment of neurologic function. Perioperative bleeding risk is high in posterior spinal fusion due to the extensive surgical exposure and potentially lengthy operative time, so the provider should undertake strategies to reduce blood loss and avoid coagulopathy. Pain management for adolescents undergoing spinal fusion is also challenging, and inadequate analgesia can delay recovery, impede patient/family satisfaction, increase the risk of chronic postsurgical pain/disability, and lead to prolonged opioid use. Many of the significant complications associated with this procedure, however, can be avoided with intentional and evidence‐based approaches covered in this review.

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Section: Error Trap 3: Failure To Prevent Excessive Bleeding Decrease...mentioning

confidence: 99%

Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery

Hammon,

Chidambaran,

Templeton

et al. 2023

Pediatric Anesthesia

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show abstract

“…It is, therefore, critical to optimise haemoglobin level and coagulation profile preoperatively, with consultation with haematological specialists, and consideration of iron supplementation or recombinant erythropoietin [ 15 , 16 ]. During the positioning of patients prone for surgery, the abdomen must be kept free from direct pressure to avoid increased venous pressure in vertebral vessels and risk of increased intraoperative bleeding within the surgical field [ 17 ].…”

Section: Intraoperative Complicationsmentioning

confidence: 99%

Paediatric Spinal Deformity Surgery: Complications and Their Management

Roberts

2022

Healthcare

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Surgical correction of paediatric spinal deformity is associated with risks, adverse events, and complications that must be preoperatively discussed with patients and their families to inform treatment decisions, expectations, and long-term outcomes. The incidence of complications varies in relation to the underlying aetiology of spinal deformity and surgical procedure. Intraoperative complications include bleeding, neurological injury, and those related to positioning. Postoperative complications include persistent pain, surgical site infection, venous thromboembolism, pulmonary complications, superior mesenteric artery syndrome, and also pseudarthrosis and implant failure, proximal junctional kyphosis, crankshaft phenomenon, and adding-on deformity, which may necessitate revision surgery. Interventions included in enhanced recovery after surgery protocols may reduce the incidence of complications. Complications must be diagnosed, investigated and managed expeditiously to prevent further deterioration and to ensure optimal outcomes. This review summarises the complications associated with paediatric spinal deformity surgery and their management.

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“…In this case, intravenous iron has the advantage over oral iron in overcoming this barrier and thereby achieve effective erythropoiesis. Previous studies have shown promising results for the use of intravenous iron therapy in patients after spinal deformity surgery but still lacking standard practice 9…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown promising results for the use of intravenous iron therapy in patients after spinal deformity surgery but still lacking standard practice. 9 …”

Section: Introductionmentioning

confidence: 99%

Effects of ferric derisomaltose on postoperative anaemia in adult spinal deformity surgery: a study protocol for a randomised controlled trial

Zhan,

Jiao,

Chen

et al. 2024

BMJ Open

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IntroductionPostoperative anaemia is prevalent in adult spinal deformity (ASD) surgery in association with unfavourable outcomes. Ferric derisomaltose, a novel iron supplement, offers a promising solution in rapidly treating postoperative anaemia. However, the clinical evidence of its effect on patients receiving spinal surgery remains inadequate. This randomised controlled trial aims to evaluate the safety and efficacy of ferric derisomaltose on postoperative anaemia in ASD patients.Methods and analysisThis single-centre, phase 4, randomised controlled trial will be conducted at Department of Orthopaedics at Peking Union Medical College Hospital and aims to recruit adult patients who received ASD surgery with postoperative anaemia. Eligible participants will be randomly assigned to receive ferric derisomaltose infusion or oral ferrous succinate. The primary outcome is the change in haemoglobin concentrations from postoperative days 1–14. Secondary outcomes include changes in iron parameters, reticulocyte parameters, postoperative complications, allogeneic red blood cell infusion rates, length of hospital stay, functional assessment and quality-of-life evaluation.Ethics and disseminationThis study has been approved by the Research Ethics Committee of Peking Union Medical College Hospital and registered at ClinicalTrials.gov. Informed consent will be obtained from all participants prior to enrolment and the study will be conducted in accordance with the principles of the Declaration of Helsinki. The results of this study are expected to be disseminated through peer-reviewed journals and academic conferences.Trial registration numberNCT05714007.

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Association between preoperative hemoglobin levels after iron supplementation and perioperative blood transfusion requirements in children undergoing scoliosis surgery

Cited by 14 publications

References 22 publications

Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery

Error traps and preventative strategies for adolescent idiopathic scoliosis spinal surgery

Paediatric Spinal Deformity Surgery: Complications and Their Management

Effects of ferric derisomaltose on postoperative anaemia in adult spinal deformity surgery: a study protocol for a randomised controlled trial

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