Perioperative Blood Management in Posterior Instrumented Fusion for Adolescent Idiopathic Scoliosis: Original Study and Short Review of the Literature

Abstract

Background: The potential hazards of allogeneic blood transfusion are well established in literature. Few things are known, however, about the results of combining different blood saving techniques and their results in avoiding allogeneic blood transfusion (ABT) in scoliosis surgery. Aim: To report specific results about utilization of preoperative autologous blood donation (PABD) and intraoperative blood-saver (BLDS) in conjunction, aiming to minimize the need for ABT. Materials and methods: Between 1989 and 2012, 107 patients underwent posterior instrumented fusion (PIF) for adolescent idiopathic scoliosis (AIS) correction. Retrospective evaluation was conducted. Patients were classified into two groups, according to the method utilized: group A with only allogeneic blood transfusion (ABT) and group B where PABD with BLDS intraoperatively was applied. Hematocrit and hemoglobin values were evaluated preoperatively, postoperatively, and at discharge. The variables we examined included also gender, age, levels fused and number of predeposited blood units, required transfused blood units (TBU), as well as ABT rates between the two groups. Results: More than 70% of the transfusions in both groups were needed intraoperatively. In group A, an average of 2.4 units per patient was transfused and ABT reached 76%. In contrast, in group B an average of 4.5 units per patient was transfused but ABT rate was only 7.3%, while the rest 92.7% was autologous blood. However, the wasted autologous blood reached 24.9%. Conclusions: Our results demonstrated that PABD with intraoperative cell salvage (CS) is associated with statistically significant ABT rates decrement but the combination of these methods cannot assure ABT avoidance.

Predictive factors for intraoperative blood loss in surgery for adolescent idiopathic scoliosis

“…ABT could decrease the potential complications from allogenic blood transfusion, namely transfusion reactions, viral/prion disease transmission, coagulopathy, and the metabolic and immunological consequences of transfusing allogeneic blood [20]. Although preoperative autologous blood donation and intraoperative blood-saver had been shown to decrease the rate of allogenic blood transfusion [21], the authors still believe that minimizing intraoperative blood loss is important during operation. Precautions include hypotensive anesthesia, subperiosteal dissection, meticulous soft tissue haemostasis at all stages, and prevention of bone bleeding with bone wax after facetectomies are performed.…”