Smaller Body Size Increases the Percentage of Blood Volume Lost During Posterior Spinal Arthrodesis

Jain, Amit; Sponseller, Paul D.; Newton, Peter O.; Shah, Suken A.; Cahill, Patrick J.; Njoku, Dolores B.; Betz, Randal R.; Samdani, Amer F.; Bastrom, Tracey P.; Marks, Michelle C.

doi:10.2106/jbjs.n.01104

Cited by 25 publications

(11 citation statements)

References 21 publications

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“…As reported by Jain et al, [25] the patients with smaller body sizes are almost always combined with worse nutritional status and greater osteopenia, which leads directly or indirectly to more blood loss during the operation. When the BMI was lower than 16.8 kg/m 2 , the risk of massive blood loss increased by 3.293 times.…”

Section: Discussionmentioning

confidence: 92%

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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Section: Discussionmentioning

confidence: 92%

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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“…A possible explanation for the relationships between blood transfusion and gender and BMI is that a smaller body size may increase intraoperative blood loss. [26] In our cohort, the mean age was 49.5 ± 15.6 years old. In North America, Europe and China, tuberculous spondylodiscitis is more commonly seen in adult patients with a mean age of 40 years [1,27].…”

Section: Factors In Uencing Intraoperative Blood Lossmentioning

confidence: 78%

Predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

Wang

Liu

Wei

et al. 2020

Preprint

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Background. During surgery for thoracic and lumbar tuberculosis infection, patients can lose a significant amount of blood and thus require a perioperative blood transfusion. However, the risk factors for increased intraoperative blood loss and perioperative blood transfusion have yet to be identified. The aim of this retrospective study was to determine the predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis. Methods. From 2008 to 2018, 336 patients who met the inclusion criteria were enrolled in the study. The predictors of allogenic blood transfusion were identified using univariate and multivariate logistic regression analyses. Univariate and multivariate linear regressions were conducted to investigate the risk factors for intraoperative blood loss. The predictors of high levels of intraoperative blood loss were analyzed by multivariate logistic regression analysis.Results. Altogether, 336 adult patients with thoracic and lumbar tuberculosis were included in this study. The mean age of patients was 49.6 ± 15.5 years old (range 14-85). Our data revealed significant relationships between blood transfusions and female gender, BMI, vertebral collapse/kyphosis and intraoperative blood loss. Multivariable linear regression analysis revealed that BMI, levels of instrumentation, surgical approach and operative time were independent risk factors for intraoperative blood loss. Specifically, a lower BMI, decreased preoperative hemoglobin levels, four or more levels of instrumentation, a combined surgical approach and a prolonged operative time were identified as risk factors for high levels of intraoperative blood loss.Conclusions. This study identified some clinical predictors of perioperative blood transfusion and intraoperative blood loss in patients undergoing thoracic and lumbar tuberculosis surgery. These results may contribute to the planning of preoperative blood transfusions and help to minimize intra- or postoperative complications. Level of evidenceLevel IV, retrospective case series.

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“…Future research is needed to determine the utility of tranexamic acid in AIS patients who undergo PSF of 9 spinal levels or fewer (typically less than 10% of total blood volume lost) to resolve remaining research questions regarding when, and in whom, tranexamic acid should be used in AIS surgeries. Although lacking in the observational literature to date, 13 surgeon variability in operative duration and blood loss should also be accounted for in multi-surgeon AIS studies.…”

Section: Discussionmentioning

confidence: 99%

“…2 Although body weight or body mass index (BMI) are commonly used as a control for body size in intraoperative blood loss studies, 2,11,12 the proportion of total blood volume lost considers blood loss as it relates to estimated total blood volume per patient. 13 The goal of this retrospective cohort study was to compare the impact of tranexamic acid versus no tranexamic acid on estimated intraoperative blood loss in AIS patients who underwent posterior spinal fusion using the percent of total blood volume lost to account for variable body mass indices.…”

Section: Introductionmentioning

confidence: 99%

Tranexamic Acid Reduced the Percent of Total Blood Volume Lost During Adolescent Idiopathic Scoliosis Surgery

et al. 2017

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Smaller Body Size Increases the Percentage of Blood Volume Lost During Posterior Spinal Arthrodesis

Abstract: There is an inverse relationship between the proportion of blood volume lost during deformity correction surgery and size in patients with adolescent idiopathic scoliosis, cerebral palsy, or Scheuermann kyphosis.

Cited by 25 publications

References 21 publications

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

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

Predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

Tranexamic Acid Reduced the Percent of Total Blood Volume Lost During Adolescent Idiopathic Scoliosis Surgery

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