Wasting of Preoperatively Donated Autologous Blood in the Surgical Treatment of Adolescent Idiopathic Scoliosis

Bess, Shay; Lenke, Lawrence G.; Bridwell, Keith H.; Steger-May, Karen; Hensley, Marsha

doi:10.1097/01.brs.0000240203.98960.13

Cited by 43 publications

(21 citation statements)

References 25 publications

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“…Such options include patients positioning to avoid abdominal compression, hypotensive anesthesia, application of topical hemostatic agents to the decorticated bone, intra-operative cell salvage (ICS) system, acute normovolemic hemodilution, and administration of medications2,3,10).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

Choi

Hyun

Kim

et al. 2017

J Korean Neurosurg Soc

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ObjectiveSpinal deformity surgery has the potential risk of massive blood loss. To reduce surgical bleeding, the use of tranexamic acid (TXA) became popular in spinal surgery, recently. The purpose of this study was to determine the effectiveness of intra-operative TXA use to reduce surgical bleeding and transfusion requirements in spinal deformity surgery.MethodsA total of 132 consecutive patients undergoing multi-level posterior spinal segmental instrumented fusion (≥5 levels) were analyzed retrospectively. Primary outcome measures included intraoperative estimated blood loss (EBL), transfusion amount and rate of transfusion. Secondary outcome measures included postoperative transfusion amount, rate of transfusion, and complications associated with TXA or allogeneic blood transfusions.ResultsThe number of patients was 89 in TXA group and 43 in non-TXA group. There were no significant differences in demographic or surgical traits between the groups except hypertension. The EBL was significantly lower in TXA group than non-TXA group (841 vs. 1336 mL, p=0.002). TXA group also showed less intra-operative and postoperative transfusion requirements (544 vs. 812 mL, p=0.012; 193 vs. 359 mL, p=0.034). Based on multiple regression analysis, TXA use could reduce surgical bleeding by 371 mL (37 % of mean EBL). Complication rate was not different between the groups.ConclusionTXA use can effectively reduce the amount of intra-operative bleeding and transfusion requirements in spinal deformity surgery. Future randomized controlled study could confirm the routine use of TXA in major spinal surgery.

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Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

Choi

Hyun

Kim

et al. 2017

J Korean Neurosurg Soc

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“…11,12 Autologous blood frequently goes unused and is wasted. 1 Finally, transfusion errors can occur and, despite PABD, patients are erroneously transfused with ALLO blood. Despite these negative features, PABD is still performed, due probably in part to physician and patient preferences to avoid ALLO blood exposure.…”

mentioning

confidence: 99%

Effectiveness of preoperative autologous blood donation for protection against allogeneic blood exposure in adult spinal deformity surgeries: a propensity-matched cohort analysis

Kelly

Zebala

Kim

et al. 2016

SPI

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OBJECT The goal of this study was to examine the effectiveness of preoperative autologous blood donation (PABD) in adult spinal deformity (ASD) surgery. METHODS Patients undergoing single-stay ASD reconstructions were identified in a multicenter database. Patients were divided into groups according to PABD (either PABD or NoPABD). Propensity weighting was used to create matched cohorts of PABD and NoPABD patients. Allogeneic (ALLO) exposure, autologous (AUTO) wastage (unused AUTO), and complication rates were compared between groups. RESULTS Four hundred twenty-eight patients were identified as meeting eligibility criteria. Sixty patients were treated with PABD, of whom 50 were matched to 50 patients who were not treated with PABD (NoPABD). Nearly one-third of patients in the PABD group (18/60, 30%) did not receive any autologous transfusion and donated blood was wasted. In 6 of these cases (6/60, 10%), patients received ALLO blood transfusions without AUTO. In 9 cases (9/60, 15%), patients received ALLO and AUTO blood transfusions. Overall rates of transfusion of any type were similar between groups (PABD 70% [42/60], NoPABD 75% [275/368], p = 0.438). Major and minor in-hospital complications were similar between groups (Major PABD 10% [6/60], NoPABD 12% [43/368], p = 0.537; Minor PABD 30% [18/60], NoPABD 24% [87/368], p = 0.499). When controlling for potential confounders, PABD patients were more likely to receive some transfusion (OR 15.1, 95% CI 2.1-106.7). No relationship between PABD and ALLO blood exposure was observed, however, refuting the concept that PABD is protective against ALLO blood exposure. In the matched cohorts, PABD patients were more likely to sustain a major perioperative cardiac complication (PABD 8/50 [16%], NoPABD 1/50 [2%], p = 0.046). No differences in rates of infection or wound-healing complications were observed between cohorts. CONCLUSIONS Preoperative autologous blood donation was associated with a higher probability of perioperative transfusions of any type in patients with ASD. No protective effect of PABD against ALLO blood exposure was observed, and no risk of perioperative infectious complications was observed in patients exposed to ALLO blood only. The benefit of PABD in patients with ASD remains undefined.

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“…One 2003 study analyzed the use of autologous pre-donated blood transfusion in surgery for scoliosis in 45 patients at one hospital in England. 23 The authors concluded that autologous blood transfusion required extra time, personnel, resources and cost £28.88 ($47.15 USD) per patient more than allogenic transfusion. 23 Additional concerns about unused autologous blood adding an unnecessary expense has been raised as well.…”

Section: Estimated Blood Volumementioning

confidence: 99%

“…23 The authors concluded that autologous blood transfusion required extra time, personnel, resources and cost £28.88 ($47.15 USD) per patient more than allogenic transfusion. 23 Additional concerns about unused autologous blood adding an unnecessary expense has been raised as well. 21,24 To date the cost of a unit of allogenic blood is variable and institution dependent.…”

Section: Estimated Blood Volumementioning

confidence: 99%

Pre-Operative Autologous Blood Donation Does Not Affect Pre-Incision Hematocrit in Adolescent Idiopathic Scoliosis Patients. A Retrospective Cohort of a Prospective Randomized Trial

et al. 2016

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Background Pre-donation of autologous blood prior to spine fusion for adolescent idiopathic scoliosis (AIS) has been used in deformity surgery. The effect of pre-donation on pre-operative hematocrit (Hct) remains debated. Multiple factors may influence pre-operative Hct including intravascular volume status, patient factors, and timing of pre-operative blood donation. The purpose of this study was to determine if pre-donation significantly lowers pre-incision Hct in AIS patients.

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Wasting of Preoperatively Donated Autologous Blood in the Surgical Treatment of Adolescent Idiopathic Scoliosis

Abstract: The majority of PABD patients (51%) wasted minimum one autologous unit or were transfused at a high hematocrit (>30). More precise PABD guidelines are needed to limit unnecessary transfusion and wasted resources.

Cited by 43 publications

References 25 publications

Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

Effectiveness and Safety of Tranexamic Acid in Spinal Deformity Surgery

Effectiveness of preoperative autologous blood donation for protection against allogeneic blood exposure in adult spinal deformity surgeries: a propensity-matched cohort analysis

Pre-Operative Autologous Blood Donation Does Not Affect Pre-Incision Hematocrit in Adolescent Idiopathic Scoliosis Patients. A Retrospective Cohort of a Prospective Randomized Trial

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