The incidence and risk factors for perioperative allogeneic blood transfusion in primary idiopathic scoliosis surgery

Mange, Tyler R.; Sucato, Daniel J.; Poppino, Kiley; Jo, Chan Hee; Ramo, Brandon R.

doi:10.1007/s43390-020-00093-6

Cited by 19 publications

(16 citation statements)

References 24 publications

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“…Their results indicated that implementation of a blood management protocol resulted in a low transfusion rate and unexpectedly led to the preoperative diagnosis in a number of patients with a low level of von Willebrand factor activity [9]. In a recently conducted research, ABT was noted in 73 (18.2%) out of 402 patients with idiopathic scoliosis [7], which is quite similar to the findings of the present study. In our research, the blood transfusion rate in cases with idiopathic scoliosis was 17.2% (64/372).…”

Section: Discussionsupporting

confidence: 87%

“…Scoliosis surgery aims to reduce the abnormal curve in the spine and prevent it from getting worse. Several studies have reported the risk factors for massive blood transfusion in patients with adolescent scoliosis [1,[4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…However, long segments of spinal fusion and osteotomy still cause a large amount of blood loss and necessitate blood transfusion. Studies have reported predictive factors for blood transfusion in scoliosis surgery; however, the majority of cases had idiopathic scoliosis [5][6][7]. The association between etiology of scoliosis and blood transfusion was scarcely reported.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

Dong

Tang

Wang

et al. 2021

BMC Musculoskelet Disord

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Background To assess the risk factors for blood transfusion in a great number of adolescent cases with different types of scoliosis who received scoliosis surgery. Methods Data of patients who were diagnosed as scoliosis and received one-stage posterior correction and spinal fusion from January 2014 to December 2017 were prospectively collected and retrospectively analyzed. Patients’ demographic characteristics, segments of spinal fusion, Cobb angle of the major curve,osteotomy pattern, preoperative and postoperative levels of hemoglobin, and allogeneic blood transfusion (ABT) were recorded and analyzed. Results In this study, 722 cases with adolescent scoliosis were included, of whom 32.8% (237/722) received ABT. Risk factors included diagnosis: neurofibromatosis (OR = 5.592), syndromic (OR = 3.029),osteotomy: Ponte osteotomy (OR = 5.997), hemivertebrae resection (OR = 29.171), pedicle subtraction osteotomy (PSO)(OR = 8.712), vertebral column resection (VCR)(OR = 32.265);fusion segments (OR = 1.224) and intraoperative blood loss (OR = 1.004). In the subgroup analysis of cases with idiopathic scoliosis, Ponte osteotomy (OR = 6.086), length of segments of spinal fusion (OR = 1.293), and intraoperative blood loss (OR = 1.001) were found as risk factors for ABT. Results of receiver operating characteristic (ROC) curve analysis revealed that length of segments of spinal fusion equal to 11.5 vertebrae was the best cutoff value for cases with idiopathic scoliosis who did not receive osteotomy in both ABT group and non-ABT group. In the subgroup analysis of congenital scoliosis, Ponte osteotomy (OR = 5.087), hemivertebra resection (OR = 5.457), PSO (OR = 4.055), VCR (OR = 6.940), and intraoperative blood loss (OR = 1.004) were risk factors for ABT. Conclusions Method of diagnosis, osteotomy pattern, segments of spinal fusion, and intraoperative blood loss were risk factors for ABT in cases with adolescent scoliosis. In cases with idiopathic scoliosis, Ponte osteotomy and segments of spinal fusion longer than 11.5 vertebrae were risk factors for ABT. In cases with congenital scoliosis, osteotomy pattern was the main risk factor for ABT. Level of evidence Level III.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

Dong

Tang

Wang

et al. 2021

BMC Musculoskelet Disord

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“…While numerous studies associate bleeding and transfusion with several perioperative and surgical factors, source data are often based on a single‐center experience, are missing key covariate data, and yield inconsistent results 5,6,11–16 . Although transfusion prediction models have been developed for several surgical procedures, such as head and neck cancer surgery, coronary artery bypass graft surgery, total joint arthroplasty, and carotid endarterectomy, these models are often limited primarily to adult patients 17–20 .…”

Section: Introductionmentioning

confidence: 99%

Development of a preoperative risk score predicting allogeneic red blood cell transfusion in children undergoing spinal fusion

et al. 2021

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Background Children undergoing spinal fusion often receive blood products. The goal of this study was to develop a preoperative score to help physicians identify those who are at risk of allogeneic red blood cell (RBC) transfusion. Study design and methods This retrospective study of children undergoing spinal fusion in the ACS‐NSQIP Pediatric database (2016–2019) aimed at identifying risk factors associated with allogeneic RBC transfusion. Univariable logistic regression and multivariable logistic regression were performed using preoperative patient characteristics and aided in the creation of a simplified scoring system. Results Out of 13,929 total patients, 2990 (21.5%) were transfused. We created a risk score based on 10 independent predictors of transfusion: age, sex, race, weight < 3rd percentile, American Society of Anesthesiologists physical status classification, cardiac risk factors, hematologic disease, preoperative anemia, deformity type, and number of spinal levels to be fused. Patients in both the training and testing cohorts were assigned a score ranging from 0 (lowest risk) to 21 (highest risk). The developed transfusion risk score showed 77% accuracy in distinguishing patients who did not receive a transfusion during or soon after surgery (AUROC 0.7736 [95% CI, 0.7619–0.7852]) in the training cohort and 77% accuracy (AUROC 0.7732 [95% CI, 0.7554–0.7910]) in the testing cohort. Discussion Our score, based on routinely available preoperative data, accurately estimates the risk of allogeneic RBC transfusion in pediatric patients undergoing spinal fusion. Future studies will inform whether patient blood management interventions targeted to high‐risk patients can help reduce the need for transfusion and improve outcomes.

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“…Surgical intervention for spinal deformities is associated with substantial blood loss [1], which is of special concern in pediatric patients due to their smaller blood volume in comparison to adults [2]. Allogeneic blood transfusion rates in pediatric patients undergoing posterior spinal fusion have been reported to range from 17.5% to 19.3% [3,4], with some institutions reporting rates as high as 31% [5].…”

Section: Introductionmentioning

confidence: 99%

Safe and Effective Performance of Pediatric Spinal Deformity Surgery in Patients Unwilling to Accept Blood Transfusion: A Clinical Study and Review of Literature

Mihas

Ramchandran

Rivera

et al. 2020

Preprint

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Background: Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah’s witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion Methods: After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018.We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up).Results: Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (15), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.40 to 11.20 (80% correction, p< 0.001) at the latest follow-up. A mean of 11.4 levels were fused, 5.6 levels of Pontes osteotomies and 2.8 levels of thoracoplasty performed. 1 patient underwent L1 VCR and 3 patients had fusion to pelvis. Estimated blood loss and cell saver returned an average of 307.9 ml and 80ml, respectively. Operative times average at 214 min. The average drop in hemoglobin after surgery was 2.1mg/dl. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative compilations were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis.Conclusions: Blood conservation techniques allow safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications.Level of Evidence: Level IV.

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The incidence and risk factors for perioperative allogeneic blood transfusion in primary idiopathic scoliosis surgery

Cited by 19 publications

References 24 publications

Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

Development of a preoperative risk score predicting allogeneic red blood cell transfusion in children undergoing spinal fusion

Safe and Effective Performance of Pediatric Spinal Deformity Surgery in Patients Unwilling to Accept Blood Transfusion: A Clinical Study and Review of Literature

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