Blood Loss During Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Koerner, John D.; Patel, Anuradha; Zhao, Chen; Schoenberg, Catherine; Mishra, Avantika; Vives, Michael J.; Sabharwal, Sanjeev

doi:10.1097/brs.0000000000000439

Cited by 64 publications

(40 citation statements)

References 31 publications

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“…Larger preoperative curve magnitudes were also associated with longer fusion segments and increased operative time. These findings are consistent with other studies showing greater blood loss with higher numbers of fused vertebrae and longer duration of surgery, particularly when more osteotomies are performed [8,16,[24][25][26][27]. Overall, the current study's findings strongly indicate that the severity of the deformity (measured by the preoperative Cobb angle) is predictive of the need for perioperative blood transfusion.…”

Section: Discussionsupporting

confidence: 91%

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Influence of curve magnitude and other variables on operative time, blood loss and transfusion requirements in adolescent idiopathic scoliosis

et al. 2015

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Section: Discussionsupporting

confidence: 91%

“…In addition, assessment of intraoperative blood loss is based on estimation of losses incurred rather than direct measurement. Another limiting factor is the lack of detailed data regarding the number of vertebral osteotomies performed in each case as this has previously been shown to significantly affect the total EBL [27].…”

Section: Discussionmentioning

confidence: 99%

Influence of curve magnitude and other variables on operative time, blood loss and transfusion requirements in adolescent idiopathic scoliosis

et al. 2015

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“…These may be patient factors such as gender, skeletal maturity, Cobb angle, kyphosis, activated partial thromboplastin time level and fibrinogen level, and menstruation cycle phase [15][16][17][18][19] or surgery-related, number of fusion level, operative time, stages of surgery, number of osteotomies, and surgical approach. 2,15,17,[19][20][21][22][23] Some of the above factors such as number of vertebral levels fused, number of screws inserted, duration of surgery, and Cobb angle demonstrated positive correlation with total blood loss in our study. Recently, a dual surgeon approach was also reported to result in shorter operative time, less blood loss, and lower risk of allogenic blood transfusion.…”

Section: Discussionmentioning

confidence: 67%

Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial

Hasan

Choe

Chan

et al. 2017

J Orthop Surg (Hong Kong)

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Background: Massive blood loss during posterior spinal fusion for adolescent idiopathic scoliosis remains a significant risk for patients. There is no consensus on the benefit of acute normovolemic hemodilution (ANH) or intraoperative cell salvage (ICS) in scoliosis surgery. Methods: Patients were randomized to one of two groups. Group A received ANH and ICS during operation, while group B received only ICS. Patients' age, sex, height, weight, body blood volume, number of fusion level, Cobb angle, number of screws, duration of surgery, and skin incision length were recorded. Hemoglobin and hematocrit levels were obtained preoperatively and postoperatively (0 h and 24 h). Results: There were 22 patients in each group. There was no significant difference in total blood loss. The perioperative decrease in hemoglobin levels between preoperation and postoperation 24 h (group A 2.79 + 1.15 and group B 2.76 + 1.00) showed no significant difference (p ¼ 0.93). Group A observed a larger decrease in hemoglobin levels at postoperative 0 h relative to preoperative level (2.57 + 0.82 g/dl), followed by a smaller decrease within the next 24 h (0.22 + 1.33 g/dl). Group B showed a continued drop in hemoglobin levels of similar magnitude at postoperation 0 h (1.60 + 0.67 g/dl) and within the next 24 h (1.16 + 0.78 g/dl). One patient from group B received 1 unit of allogenic blood transfusion (p ¼ 0.33). Conclusions: The addition of ANH to ICS in posterior spinal fusion surgery for AIS resulted in a similar decrease in hemoglobin levels between preoperative values and at 24 h postoperatively.

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“…As young patients grow up, they may be predisposed to a more rigid curve, and lower curve flexibility may be related to blood loss. [26] During our study, the risk of massive blood loss increased 3.505 times with patients older than 15 years. Duration of operation had a positive correlation with blood loss (Pearson correlation r value = 0.602, P < 0.001, data not listed).…”

Section: Discussionmentioning

confidence: 68%

Incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with neuromuscular scoliosis

Jia

Li²,

Xu³

et al. 2017

Medicine

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Factors influencing massive blood loss for neuromuscular scoliosis (NMS) patients.Despite advances in surgical and anesthetic techniques, scoliosis surgery is still associated with intraoperative massive blood loss, which can result in postoperative mortality and morbidity. The aim of this study was to assess the incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with NMS.A retrospective review of adolescents who underwent posterior spinal instrumentation and fusion for NMS was performed. Perioperative variables and data were recorded. Massive blood loss was defined as an estimated blood loss that exceeds 30% of total blood volume.We obtained data for 114 patients, of whom 63 (55%) had intraoperative massive blood loss. Compared with those without, patients with massive blood loss were more likely to be older, have lower body mass indexes (BMIs), larger Cobb angles, more fused levels, more osteotomy procedures, and prolonged duration of operation. Logistic regression analysis identified the number of fused levels to be more than 12 (P = 0.003, odds ratio = 6.614, 95% confidence interval [CI]: 1.891–23.131), BMI lower than 16.8 kg/m2 (P = 0.025, odds ratio = 3.293, 95% CI: 1.159–9.357), age greater than 15 years (P = 0.014, odds ratio = 3.505, 95% CI: 1.259–9.761), and duration of operation longer than 4.4 hours (P = 0.016, odds ratio = 3.746, 95% CI: 1.428–9.822) as influencing factors. Patients with massive blood loss are associated with more intraoperative colloids infusion and blood transfusions (red blood cell and fresh frozen plasma), as well as postoperative drainage volume.In adolescents with NMS who underwent posterior spinal instrumentation and fusion operations, intraoperative massive blood loss is common. The number of fused levels, BMI, age, and duration of operation are factors influencing intraoperative massive blood loss.

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Blood Loss During Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Abstract: 4.

Cited by 64 publications

References 31 publications

Influence of curve magnitude and other variables on operative time, blood loss and transfusion requirements in adolescent idiopathic scoliosis

Influence of curve magnitude and other variables on operative time, blood loss and transfusion requirements in adolescent idiopathic scoliosis

Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial

Incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with neuromuscular scoliosis

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