Predictive factors for perioperative blood transfusion in surgeries for correction of idiopathic, neuromuscular or congenital scoliosis

Abstract

OBJECTIVE:To evaluate the association of clinical and demographic variables in patients requiring blood transfusion during elective surgery to treat scoliosis with the aim of identifying markers predictive of the need for blood transfusion.METHODS:Based on the review of medical charts at a public university hospital, this retrospective study evaluated whether the following variables were associated with the need for red blood cell transfusion (measured by the number of packs used) during scoliosis surgery: scoliotic angle, extent of arthrodesis (number of fused levels), sex of the patient, surgery duration and type of scoliosis (neuromuscular, congenital or idiopathic).RESULTS:Of the 94 patients evaluated in a 55-month period, none required a massive blood transfusion (most patients needed less than two red blood cell packs). The number of packs was not significantly associated with sex or type of scoliosis. The extent of arthrodesis (r = 0.103), surgery duration (r = 0.144) and scoliotic angle (r = 0.004) were weakly correlated with the need for blood transfusion. Linear regression analysis showed an association between the number of spine levels submitted to arthrodesis and the volume of blood used in transfusions (p = 0.001).CONCLUSION:This study did not reveal any evidence of a significant association between the need for red blood cell transfusion and scoliotic angle, sex or surgery duration in scoliosis correction surgery. Submission of more spinal levels to arthrodesis was associated with the use of a greater number of blood packs.

Preoperative anemia increases the risk of red blood cell transfusion and prolonged hospital length of stay in children undergoing spine arthrodesis surgery

“…Spine surgery can be associated with significant intraoperative blood loss and may require the transfusion of large volumes of blood products . Identified risk factors for bleeding and transfusion requirement in patients undergoing spine arthrodesis include severity of spine deformities, posterior approach, number of levels fused, bone marrow density, prolonged surgical duration, and low BMI . In addition, surgery for neuromuscular scoliosis is associated with higher intraoperative blood loss and transfusion requirements compared with surgery for idiopathic scoliosis .…”

Coagulative function assessed preoperatively via the clot formation and lysis assay as a prognostic factor for blood loss in adolescents undergoing posterior spinal fusion for idiopathic scoliosis

“…Factors associated with blood loss in PSF for scoliosis or kyphosis have been investigated mostly in retrospective studies . These studies have implicated the following patient and surgical risk factors for blood loss: Cobb angle >50°, female gender, African American race, anemia, known bleeding disorders, abnormal coagulation profiles, neuromuscular scoliosis, operative time, posterior lumbar fusion, number of levels fused, and use of Ponte osteotomies . Ryan and colleagues found that children with scoliosis have a high prevalence of abnormalities in screening coagulation laboratory tests obtained preoperatively compared with healthy patients, primarily the prothrombin time .…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] These studies have implicated the following patient and surgical risk factors for blood loss: Cobb angle >50°, female gender, African American race, anemia, known bleeding disorders, abnormal coagulation profiles, neuromuscular scoliosis, operative time, posterior lumbar fusion, number of levels fused, and use of Ponte osteotomies. [2][3][4][5][6][7][8][9][10][11][12] Ryan and colleagues found that children with scoliosis have a high prevalence of abnormalities in screening coagulation laboratory tests obtained preoperatively compared with healthy patients, primarily the prothrombin time. 2 Although the etiologies of these coagulation abnormalities were not elucidated, factor X levels in this study were lower in scoliosis patients than healthy controls.…”

Dilutional coagulopathy in pediatric scoliosis surgery: A single center report

“…Identifying those patients at risk for increased blood loss or transfusion is a critical and elusive goal in these surgeries. Many of the identified risk factors for bleeding or transfusion in these surgeries are relatively unalterable preoperative demographics or required surgical constraints . These include surgical duration, Cobb angle, and patient weight.…”

“…Many of the identified risk factors for bleeding or transfusion in these surgeries are relatively unalterable preoperative demographics or required surgical constraints. 3,[12][13][14][15][16][17] These include surgical duration, Cobb angle, and patient weight. Directly increasing red blood cell mass with preoperative erythropoietin may be used, but this is not routinely practiced in our institution due to time and geographical restraints, the increased need for frequent preoperative monitoring of red cell mass and FDA black box warning for perisurgical administration.…”