Does Menses Affect the Risk of Blood Loss in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion Surgeries?

Abstract

Study Design. Retrospective propensity score matching study. Objective. To investigate whether menses affect intraoperative blood loss in female adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) surgeries. Summary of Background Data. There were concerns whether patients having menses will have higher intraoperative blood loss if surgery were to be done during this period. Methods. This study included 372 females who were operated between May 2016 to May 2019. Fifty-five patients had menses during surgery (Group 1, G1) and 317 patients did not have menses during surgery (Group 2, G2). Propensity score matching (PSM) analysis with one-to-one, nearest neighbor matching technique and with a match tolerance of 0.001 was used. The main outcome measures were intraoperative blood loss (IBL), volume of blood salvaged, transfusion rate, preoperative hemoglobin, preoperative platelet, preoperative prothrombin time, preoperative activated partial thromboplastin time (APTT), international normalized ratio (INR), and postoperative hemoglobin. Postoperative Cobb angle and correction rate were also documented. Results. At the end of PSM analysis, 46 patients from each group were matched and balanced. The average operation duration for G1 was 140.8 ± 43.0 minutes compared with 143.1 ± 48.3 minutes in G2 (P = 0.806). The intraoperative blood loss for G1 was 904.3 ± 496.3 mL and for G2 was 907.9 ± 482.8 mL (P = 0.972). There was no significant difference in terms of normalized blood loss (NBL), volume of blood salvaged during surgery, preoperative hemoglobin, postoperative hemoglobin, hemoglobin drift, estimated blood volume (EBV), IBL per EBV and IBL per level fused (P > 0.05). No postoperative complications were encountered in both groups. On average, the postoperative hospital stay was 3.5 ± 0.8 days for both groups (P = 0.143). Conclusion. Performing corrective surgery during the menstrual phase in female AIS patients is safe without risk of increased blood loss. Level of Evidence: 4

Does Progesterone Affect Perioperative Blood Loss during Posterior Spinal Fusion Surgeries in Female Patients with Adolescent Idiopathic Scoliosis? A Retrospective Study

“…However, Chiu et al . 25 compared AIS patients who underwent PSF during the menstrual period with those who underwent PSF during the non‐menstrual period and found no significant difference in IBL. In our institution, PSF surgery is usually not performed during menstruation for the following reasons.…”

“…To avoid the influence of weight and the number of fusion levels, NBL was calculated; however, there was still no significant difference even after considering these variables. Our results were similar to those of Chiu et al ., 25 but their study group was AIS patients underwent PSF surgery during menstruation. Allogeneic blood transfusion rates were higher in progesterone injection group (14.6%) than in control group (7.3%); however, this difference was not statistically significant either.…”

“…In the study, menstruation was considered a contraindication for PSF surgery; thus, they avoided performing it on patients during menstruation due to concern about increased perioperative blood loss. However, Chiu et al 25 compared AIS patients who underwent PSF during the menstrual period with those who underwent PSF during the nonmenstrual period and found no significant difference in IBL. In our institution, PSF surgery is usually not performed during menstruation for the following reasons.…”