Quais fatores podem influenciar perdas sanguíneas extensas no tratamento cirúrgico da escoliose neuromuscular?

Maio, Marta; Carvalho, Alfredo; Pinho, André; Serdoura, Francisco; Veludo, Vitorino

doi:10.1055/s-0039-3400527

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…IAT signi cantly reduced the requirement for allogeneic RBC transfusion when the volume of blood lost was ≥1000 mL. Our ndings are similar to those of Ersen et al [2] and Miao et al [13]. In Ersen et al's study, the average intraoperative blood loss volume was approximately 1000 mL.…”

Section: Discussionsupporting

confidence: 88%

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A Cost-Effectiveness Analysis Of Intraoperative Autologous Transfusion In Adolescent Idiopathic Scoliosis Surgery: A Single-center Retrospective Study

Chi

Luo

et al. 2023

Preprint

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Background: Intraoperative autologous transfusion(IAT) has been used in scoliosis surgery for decades; however, its cost-effectiveness remains debatable. Therefore, this study aimed to evaluate the cost-effectiveness of IAT in adolescent idiopathic scoliosis (AIS) surgery with different blood loss volumes. Methods: The medical records of 402 patients who underwent AIS surgery were reviewed. Depending on the volume of blood lost during the operation, the patients were divided into three groups: A (≥500 to <1000 mL), B (≥1,000 to <1,500 mL), and C (≥1,500mL). Depending on whether IAT was used, each group was further divided into the IAT and no-IAT groups. The volume of blood loss, volume of transfused allogeneic red blood cells (RBC),and RBC transfusioncosts were analyzed.Univariate and multivariate logistic regression analyses were used to identify the independent risk factors of massive intraoperative blood loss (≥1,000 mL and ≥1,500 mL). A receiver operating characteristic (ROC) curve was used to analyze the cutoff values of the factors contributing to massive intraoperative blood loss. Results: In group B, the IAT group had a lower volume of allogeneic RBC transfused than the no-IAT group, whereas the total RBC transfusion cost in the IAT group was significantly higher than that in the no-IAT group. In group C, the volume of allogeneic RBC transfused in the IAT group reduced significantly more than that in the no-IAT group. The number of vertebral levels fused was found to be an independent risk factor for massive intraoperative blood loss. Conclusion: The cost-effectiveness of IAT in AIS is related to the volume of blood lost. The number of fused vertebral levels is an independent risk factor that can effectively predict massive intraoperative blood loss.

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Section: Discussionsupporting

confidence: 88%

“…However, the operation is complicated and causes massive intraoperative blood loss (650-2,839 mL) [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

A Cost-Effectiveness Analysis Of Intraoperative Autologous Transfusion In Adolescent Idiopathic Scoliosis Surgery: A Single-center Retrospective Study

Chi

Luo

et al. 2023

Preprint

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“…In their study of 1859 AIS patients, Song et al divided their dataset into massive (>30% of estimated blood volume) and non-massive (<30% EBV) blood loss groups and found that longer operation duration, more number of fusion levels, lower BMI, larger preoperative Cobb angle, lower preoperative platelet count, and increasing bleeding time (INR) were independent risk factors for massive blood loss [19]. In a similar setting with NMS patients, Maio et al found that lower BMI was a risk factor for massive blood loss associated with spinal fusion [24]. Additionally, Jia et al conducted a similar study of massive blood loss in NMS and discovered that a greater number of fusion levels, a BMI lower than 16.8, an age greater than 15 years, and a duration longer than 4.4 h were all risk factors for massive blood loss [22].…”

Section: Comparison To Literaturementioning

confidence: 99%

“…In previous studies, longer operative time, lower BMI, more extensive fusion, larger preoperative cobb angle for main curve, and platelet levels have played roles in more extensive bleeding concerning AIS patients [17][18][19][20][21]. In comparison, in NMS patients, lower BMI, higher age, larger preoperative main curvature, preoperative hematocrit, older age, and number of osteotomies have been described to influence more voluminous intraoperative bleeding [22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Risk Factors for Bleeding in Adolescents Undergoing Pedicle Screw Instrumentation for Scoliosis

et al. 2023

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Progressive scoliosis eventually leads to extensive spinal fusion surgery, which carries a risk for significant bleeding. Neuromuscular scoliosis (NMS) patients have an additional inherent risk of major perioperative bleeding. The purpose of our research was to investigate the risk factors for measured (intraoperative, drain output) and hidden blood loss related to pedicle screw instrumentation in adolescents, divided into adolescent idiopathic scoliosis (AIS) and NMS patient groups. A retrospective cohort study with prospectively collected data of consecutive AIS and NMS patients undergoing segmental pedicle screw instrumentation at a tertiary level hospital between 2009 and 2021 was conducted. In total, 199 AIS (mean age 15.8 years, 143 females) and 81 NMS patients (mean age 15.2 years, 37 females) were included in the analysis. In both groups, levels fused, increased operative time, and smaller or larger size of erythrocytes were associated with perioperative blood loss (p < 0.05 for all correlations). In AIS, male sex (p < 0.001) and the number of osteotomies correlated with more drain output. In NMS, levels fused correlated with drain output, p = 0.00180. In AIS, patients’ lower preoperative MCV levels (p = 0.0391) and longer operation times, p = 0.0038, resulted into more hidden blood loss, but we did not find any significant risk factors for hidden blood loss in NMS patients.

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“…Adolescent idiopathic scoliosis (AIS) is a common spinal deformity, and posterior instrumentation and fusion is a common method for treating AIS [ 1 ]. However, the operation is complicated and causes massive intraoperative blood loss (650–2,839 mL) [ 2 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

A cost-effectiveness analysis of intraoperative autologous transfusion in adolescent idiopathic scoliosis surgery: a single-centre retrospective study

Chi

Luo

et al. 2023

BMC Anesthesiol

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Background Intraoperative autologous transfusion (IAT) has been used in scoliosis surgery for decades; however, its cost-effectiveness remains debatable. This study aimed to evaluate the cost-effectiveness of IAT in adolescent idiopathic scoliosis (AIS) surgery and identify risk factors of massive intraoperative blood during this surgery. Methods The medical records of 402 patients who underwent AIS surgery were reviewed. The patients were divided into different groups according to the intraoperative blood loss volume (group A: ≥500 to < 1000 mL, B: ≥1,000 to < 1,500 mL, and C: ≥1,500 mL) and whether IAT was used (i.e., IAT and no-IAT groups). The volume of blood loss, volume of transfused allogeneic red blood cells (RBC), and RBC transfusion costs were analysed. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors of massive intraoperative blood loss (≥ 1,000 mL and ≥ 1,500 mL). A receiver operating characteristic (ROC) curve was used to analyse the cut-off values of the factors contributing to massive intraoperative blood loss. Results In group A, no significant difference was observed in the volume of allogeneic RBC transfused during and after procedure between the IAT and no-IAT groups; however, total RBC transfusion costs was significantly higher in the IAT group. In groups B and C, the patients in the IAT group compared with those in the no-IAT group had a lower volume of allogeneic RBC transfused during the operation and on the first day after the operation. However, in group B, the total RBC transfusion cost in the patients who used IAT was significantly higher. In group C, total RBC transfusion cost in the patients who used IAT was significantly lower. The number of fused vertebral levels and Ponte osteotomy were found to be independent risk factors for massive intraoperative blood loss. ROC analysis showed that more than eight and 10 fused vertebral levels predicted ≥ 1,000 mL and ≥ 1,500 mL intraoperative blood loss, respectively. Conclusion The cost-effectiveness of IAT in AIS was related to the volume of blood loss, and when the blood loss volume was ≥ 1,500 mL, IAT was cost-effective, drastically reducing the demand for allogeneic RBC and total RBC transfusion cost. The number of fused vertebral levels and Ponte osteotomy were independent risk factors for massive intraoperative blood loss.

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Quais fatores podem influenciar perdas sanguíneas extensas no tratamento cirúrgico da escoliose neuromuscular?

Cited by 5 publications

References 12 publications

A Cost-Effectiveness Analysis Of Intraoperative Autologous Transfusion In Adolescent Idiopathic Scoliosis Surgery: A Single-center Retrospective Study

A Cost-Effectiveness Analysis Of Intraoperative Autologous Transfusion In Adolescent Idiopathic Scoliosis Surgery: A Single-center Retrospective Study

Perioperative Risk Factors for Bleeding in Adolescents Undergoing Pedicle Screw Instrumentation for Scoliosis

A cost-effectiveness analysis of intraoperative autologous transfusion in adolescent idiopathic scoliosis surgery: a single-centre retrospective study

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