The pattern of blood loss in adolescent idiopathic scoliosis

Dmitri Van Popta, John Stephenson, Davandra Patel, Rajat Verma

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Study design This was a retrospective case series. Surgeries were performed by one of four substantive pediatric spinal surgeons within a single regional center over a 3-year period.

Patient sample A consecutive series of 86 patients who underwent posterior instrumented fusion for AIS were included: 10 males and 76 females. Mean age was 14 years (range 10-17 years). All patients had posterior instrumented fusion using various blood-saving techniques (eg, cell-saver). All patients were cross-matched preoperatively, and our transfusion trigger value (TTV) was 7 g/dL.

Outcome measures Hemoglobin level was the outcome measure. Hemoglobin readings were obtained preoperatively, within 2 hours of surgery, and daily up to 5 days after surgery. This physiologic measure was assessed using routine blood sampling techniques and standardized laboratory processing.

Methods Patient predictor variables (demographic and surgical) were assessed for association with Hb levels in a hierarchical model, with repeated Hb readings at the lower level being clustered within an individual patient at the upper level of the structure. The variation of Hb levels within individuals was compared with mean levels in different individuals via the variance partition coefficient of the model structure.

Results No patients required intraoperative allogeneic transfusion. Only four patients (4.65%) received allogeneic transfusion, all within 2 days of surgery. A clinically important drop in Hb occurred within the first 2 postoperative days, rising thereafter. The average postoperative drop in Hb was 4.1 g/dL. Young males had lower postoperative Hb values. Neither the preoperative curve magnitude (Cobb angle of major curve) nor the number of vertebrae/levels fused significantly affected the blood loss.

Conclusions We recommend setting a minimum preoperative Hb value that is 5 g/dL higher than your TTV. Because no patients required an intraoperative transfusion when using modern blood-saving techniques, preoperative cross-matching is unnecessary and potentially wasteful of blood reserves. Hemoglobin analysis beyond the second postoperative day is unnecessary unless clinically indicated.

Background context Previous studies have shown that modern intraoperative blood-saving techniques dramatically reduce the allogeneic transfusion requirements in surgery for adolescent idiopathic scoliosis (AIS). No studies have looked at the pattern of postoperative hemoglobin (Hb) in AIS patients undergoing corrective spinal surgery and correlated this with the timing of allogeneic transfusion.

LanguageEnglish
Pages2938-2945
Number of pages8
JournalSpine Journal
Volume14
Issue number12
DOIs
Publication statusPublished - 1 Dec 2014

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Scoliosis
Hemoglobins
Ambulatory Surgical Procedures
Reading
Outcome Assessment (Health Care)
Spine
Demography
Pediatrics

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Van Popta, Dmitri ; Stephenson, John ; Patel, Davandra ; Verma, Rajat. / The pattern of blood loss in adolescent idiopathic scoliosis. In: Spine Journal. 2014 ; Vol. 14, No. 12. pp. 2938-2945.
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abstract = "Study design This was a retrospective case series. Surgeries were performed by one of four substantive pediatric spinal surgeons within a single regional center over a 3-year period.Patient sample A consecutive series of 86 patients who underwent posterior instrumented fusion for AIS were included: 10 males and 76 females. Mean age was 14 years (range 10-17 years). All patients had posterior instrumented fusion using various blood-saving techniques (eg, cell-saver). All patients were cross-matched preoperatively, and our transfusion trigger value (TTV) was 7 g/dL.Outcome measures Hemoglobin level was the outcome measure. Hemoglobin readings were obtained preoperatively, within 2 hours of surgery, and daily up to 5 days after surgery. This physiologic measure was assessed using routine blood sampling techniques and standardized laboratory processing.Methods Patient predictor variables (demographic and surgical) were assessed for association with Hb levels in a hierarchical model, with repeated Hb readings at the lower level being clustered within an individual patient at the upper level of the structure. The variation of Hb levels within individuals was compared with mean levels in different individuals via the variance partition coefficient of the model structure.Results No patients required intraoperative allogeneic transfusion. Only four patients (4.65{\%}) received allogeneic transfusion, all within 2 days of surgery. A clinically important drop in Hb occurred within the first 2 postoperative days, rising thereafter. The average postoperative drop in Hb was 4.1 g/dL. Young males had lower postoperative Hb values. Neither the preoperative curve magnitude (Cobb angle of major curve) nor the number of vertebrae/levels fused significantly affected the blood loss.Conclusions We recommend setting a minimum preoperative Hb value that is 5 g/dL higher than your TTV. Because no patients required an intraoperative transfusion when using modern blood-saving techniques, preoperative cross-matching is unnecessary and potentially wasteful of blood reserves. Hemoglobin analysis beyond the second postoperative day is unnecessary unless clinically indicated.Background context Previous studies have shown that modern intraoperative blood-saving techniques dramatically reduce the allogeneic transfusion requirements in surgery for adolescent idiopathic scoliosis (AIS). No studies have looked at the pattern of postoperative hemoglobin (Hb) in AIS patients undergoing corrective spinal surgery and correlated this with the timing of allogeneic transfusion.",
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The pattern of blood loss in adolescent idiopathic scoliosis. / Van Popta, Dmitri; Stephenson, John; Patel, Davandra; Verma, Rajat.

In: Spine Journal, Vol. 14, No. 12, 01.12.2014, p. 2938-2945.

Research output: Contribution to journalArticle

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N2 - Study design This was a retrospective case series. Surgeries were performed by one of four substantive pediatric spinal surgeons within a single regional center over a 3-year period.Patient sample A consecutive series of 86 patients who underwent posterior instrumented fusion for AIS were included: 10 males and 76 females. Mean age was 14 years (range 10-17 years). All patients had posterior instrumented fusion using various blood-saving techniques (eg, cell-saver). All patients were cross-matched preoperatively, and our transfusion trigger value (TTV) was 7 g/dL.Outcome measures Hemoglobin level was the outcome measure. Hemoglobin readings were obtained preoperatively, within 2 hours of surgery, and daily up to 5 days after surgery. This physiologic measure was assessed using routine blood sampling techniques and standardized laboratory processing.Methods Patient predictor variables (demographic and surgical) were assessed for association with Hb levels in a hierarchical model, with repeated Hb readings at the lower level being clustered within an individual patient at the upper level of the structure. The variation of Hb levels within individuals was compared with mean levels in different individuals via the variance partition coefficient of the model structure.Results No patients required intraoperative allogeneic transfusion. Only four patients (4.65%) received allogeneic transfusion, all within 2 days of surgery. A clinically important drop in Hb occurred within the first 2 postoperative days, rising thereafter. The average postoperative drop in Hb was 4.1 g/dL. Young males had lower postoperative Hb values. Neither the preoperative curve magnitude (Cobb angle of major curve) nor the number of vertebrae/levels fused significantly affected the blood loss.Conclusions We recommend setting a minimum preoperative Hb value that is 5 g/dL higher than your TTV. Because no patients required an intraoperative transfusion when using modern blood-saving techniques, preoperative cross-matching is unnecessary and potentially wasteful of blood reserves. Hemoglobin analysis beyond the second postoperative day is unnecessary unless clinically indicated.Background context Previous studies have shown that modern intraoperative blood-saving techniques dramatically reduce the allogeneic transfusion requirements in surgery for adolescent idiopathic scoliosis (AIS). No studies have looked at the pattern of postoperative hemoglobin (Hb) in AIS patients undergoing corrective spinal surgery and correlated this with the timing of allogeneic transfusion.

AB - Study design This was a retrospective case series. Surgeries were performed by one of four substantive pediatric spinal surgeons within a single regional center over a 3-year period.Patient sample A consecutive series of 86 patients who underwent posterior instrumented fusion for AIS were included: 10 males and 76 females. Mean age was 14 years (range 10-17 years). All patients had posterior instrumented fusion using various blood-saving techniques (eg, cell-saver). All patients were cross-matched preoperatively, and our transfusion trigger value (TTV) was 7 g/dL.Outcome measures Hemoglobin level was the outcome measure. Hemoglobin readings were obtained preoperatively, within 2 hours of surgery, and daily up to 5 days after surgery. This physiologic measure was assessed using routine blood sampling techniques and standardized laboratory processing.Methods Patient predictor variables (demographic and surgical) were assessed for association with Hb levels in a hierarchical model, with repeated Hb readings at the lower level being clustered within an individual patient at the upper level of the structure. The variation of Hb levels within individuals was compared with mean levels in different individuals via the variance partition coefficient of the model structure.Results No patients required intraoperative allogeneic transfusion. Only four patients (4.65%) received allogeneic transfusion, all within 2 days of surgery. A clinically important drop in Hb occurred within the first 2 postoperative days, rising thereafter. The average postoperative drop in Hb was 4.1 g/dL. Young males had lower postoperative Hb values. Neither the preoperative curve magnitude (Cobb angle of major curve) nor the number of vertebrae/levels fused significantly affected the blood loss.Conclusions We recommend setting a minimum preoperative Hb value that is 5 g/dL higher than your TTV. Because no patients required an intraoperative transfusion when using modern blood-saving techniques, preoperative cross-matching is unnecessary and potentially wasteful of blood reserves. Hemoglobin analysis beyond the second postoperative day is unnecessary unless clinically indicated.Background context Previous studies have shown that modern intraoperative blood-saving techniques dramatically reduce the allogeneic transfusion requirements in surgery for adolescent idiopathic scoliosis (AIS). No studies have looked at the pattern of postoperative hemoglobin (Hb) in AIS patients undergoing corrective spinal surgery and correlated this with the timing of allogeneic transfusion.

KW - Adolescent

KW - Blood loss

KW - Hemoglobin

KW - Scoliosis

KW - Transfusion

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