The Relative Efficacy of Antifibrinolytics in Adolescent Idiopathic Scoliosis

Verma, Kushagra; Errico, Thomas J.; Diefenbach, C.; Hoelscher, Christian; Peters, Austin; Dryer, Joseph; Huncke, Tessa; Boenigk, Kirstin; Lonner, Baron S.

doi:10.2106/jbjs.l.00008

Cited by 104 publications

(67 citation statements)

References 24 publications

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“…Multiple studies have demonstrated the potential effectiveness of intraoperative antifibrinolytic therapy in significantly reducing blood loss (A. Soroceanu et al, unpublished data). 9,36,65 In addition, a recently published application of rotational thromboelastometry-guided blood product management to major spine procedures suggests that this technology may aid in reducing blood loss, blood product use, and cost. 31 Infections accounted for 9% of all major complications, and deep wound infection was the most common infection.…”

Section: Discussionmentioning

confidence: 99%

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Smith

Klineberg

Lafage

et al. 2016

SPI

300

178

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OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82 patients (28.2%). A total of 270 perioperative complications (145 minor; 125 major) were reported, with 152 patients (52.2%) affected, and a total of 199 delayed complications (62 minor; 137 major) were reported, with 124 patients (42.6%) affected. Overall, 469 complications (207 minor; 262 major) were documented, with 203 patients (69.8%) affected. The most common complication categories included implant related, radiographic, neurological, operative, cardiopulmonary, and infection. Higher complication rates were associated with older age (p = 0.009), greater body mass index (p ≤ 0.031), increased comorbidities (p ≤ 0.007), previous spine fusion (p = 0.029), and 3-column osteotomies (p = 0.036). Cases in which 2-year follow-up was not achieved included 2 perioperative mortalities (pulmonary embolus and inferior vena cava injury). CONCLUSIONS This study provides an assessment of complications associated with ASD surgery based on a prospective, multicenter design and with a minimum 2-year follow-up. Although the overall complication rates were high, in interpreting these findings, it is important to recognize that not all complications are equally impactful. This study represents one of the most complete and detailed reports of perioperative and delayed complications associated with ASD surgery to date. These findings may prove useful for treatment planning, patient counseling, benchmarking of complication rates, and efforts to improve the safety and cost-effectiveness of patient care.

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Section: Discussionmentioning

confidence: 99%

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Smith

Klineberg

Lafage

et al. 2016

SPI

300

178

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“…There may be a benefit to reducing operative blood loss in order to reduce postoperative LOS. Several methods of reducing intraoperative blood loss show promise, including, tranexamic acid [26,47,53], use of a bipolar sealer [15,28], and intrathecal morphine [23]. While minimally invasive procedures have been reported to reduce postoperative LOS and blood loss in patients treated with other spinal procedures [10,36,40,48], minimally invasive surgery for AIS has not yet shown the same benefits [39].…”

Section: Discussionmentioning

confidence: 99%

Patient Factors Are Associated With Poor Short-term Outcomes After Posterior Fusion for Adolescent Idiopathic Scoliosis

Basques

Bohl

Golinvaux

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Furthermore, anti-fibrinolytic agents such as Transexamic Acid (TXA) and aminocaproic acid have been shown to decrease intraoperative blood loss and transfusion rates, as evidenced by recent systematic reviews and meta-analysis studies [17][18][19]. Most of the studies have been small, single-center and prospective or retrospective in nature.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the studies have been small, single-center and prospective or retrospective in nature. Recently, a prospective randomized trial involving 125 patients with AIS showed that both TXA and aminocaproic acid reduced intraoperative blood loss when compared with saline solution [19], although they did not find a decrease in transfusion rates. However, in the Jehovah's Witness population where transfusion is not an option, reducing intraoperative blood loss is the primary goal.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Management of Scoliosis in JehovahÂ’s Witness Patients: One InstitutionÂ’s Experience

Hoashi¹,

Brimmo²,

Kolmodin³

et al. 2015

J Spine

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The Relative Efficacy of Antifibrinolytics in Adolescent Idiopathic Scoliosis

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 104 publications

References 24 publications

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Patient Factors Are Associated With Poor Short-term Outcomes After Posterior Fusion for Adolescent Idiopathic Scoliosis

Surgical Management of Scoliosis in JehovahÂ’s Witness Patients: One InstitutionÂ’s Experience

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