Blood Loss Trends and Financial Implications in Adolescent Idiopathic Scoliosis

Alamanda, Vignesh K.; Massengill, Danae L; Rozario, Nigel; Moore, Charity G.; Scannell, Brian P.; Brighton, Brian; Vanderhave, Kelly L.

doi:10.1097/bsd.0000000000000689

Cited by 14 publications

(9 citation statements)

References 18 publications

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“…4,10 The present study also found that male patients have more HBL which is consistent with previous studies. 4,10,18,19 The reason why male patients have more HBL may be related to the greater height and weight and higher blood volume. These factors together with higher Hb content led to more serious blood loss when male patients lose the same volume of blood.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Hidden Blood Loss in Elderly Cervical Spondylosis Patients With Anterior Cervical Discectomy Fusion and Influencing Factors

Cai

Chen

Wang

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: To analyze the perioperative hidden blood loss (HBL) and its influencing factors in elderly cervical spondylosis patients treated with anterior cervical discectomy fusion (ACDF). Materials and Methods: From January 2017 to December 2018, 128 elderly cervical spondylosis patients (age > 65 y) treated with ACDF were selected. The patients’ height, weight, duration of symptoms, previous medical history and other basic information were routinely recorded. The hemoglobin (Hb), hematocrit (Hct) and blood coagulation function preoperative and the next day postoperative were recorded. The operation time, surgical bleeding, ASA classification, fixation method, total drainage and the time for extraction of drainage tube were recorded. The total blood loss (TBL) was calculated according to the Gross’s formula, and HBL was calculated based on TBL, total drainage and surgical bleeding. The statistical analysis of HBL was performed, and then influential factors were further analyzed by multivariate linear regression analysis and t test. Results: The mean surgical bleeding was 102.70 ± 46.78 mL and HBL was 487.98 ± 255.96 mL. HBL accounted for 67.61 ± 5.20% of TBL. According to the multiple linear regression analysis, the gender (P = 0.047), operation time (P = 0.000), fixation method (P = 0.014) and international normalized ratio (INR) (P = 0.003) influenced the amount of HBL. Body mass index (BMI) (P = 0.624), hypertension (P = 0.977), diabetes (P = 0.528), blood type (P = 0.577), ASA classification (P = 0.711), duration of symptoms (P = 0.661), preoperative cobb angle (P = 0.152), number of surgical level (P = 0.709), intramedullary hyperintensity (P = 0.967), drainage time (P = 0.294), postoperative drainage volume (P = 0.599), prothrombin time (PT) (P = 0.674), activated partial thromboplastin time (APTT) (P = 0.544) and thrombin time (TT) (P = 0.680) had no correlation with the amount of HBL. Conclusions: There was obvious HBL during the perioperative period of ACDF in elderly cervical spondylosis patients. The male patients, longer operation time, fusion with titanium plate and cage and high INR were independent risk factors for HBL.

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Section: Discussionmentioning

confidence: 99%

Perioperative Hidden Blood Loss in Elderly Cervical Spondylosis Patients With Anterior Cervical Discectomy Fusion and Influencing Factors

Cai

Chen

Wang

et al. 2021

Geriatr Orthop Surg Rehabil

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“…In patients with high expected blood loss, such as those undergoing surgery for adolescent idiopathic scoliosis, ICS has been found to be cost-neutral compared to allogeneic blood transfusion. 99 Most studies have found ICS to have a very low complication profile, though at least one study has reported acute kidney injury in the setting of ICS transfusion. 100…”

Section: Intraoperative Cell Salvagementioning

confidence: 99%

Minimizing Blood Loss in Spine Surgery

Mikhail

Pennington

Arnold

et al. 2020

Global Spine Journal

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Study Design: Broad narrative review. Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery. Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery. Results: There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements. Conclusion: As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.

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“…There is some data to suggest that EBL is higher in male patients compared to female patients with AIS. 14 The sex distribution between cohorts may have been a confounding variable.…”

Section: Discussionmentioning

confidence: 99%

“…Based on a previous retrospective cohort study in a similar target population, 14 we anticipated EBL/level in the proposed study would be 48 mL/level (AE30) in the experimental group and 72 mL/level (AE28) in the control group. Based on a two-sided, alpha level of 0.05, we determined that a sample size of 62 subjects (31 subjects per group) would provide 90% power to detect a 24 mL/level reduction in blood loss with USBS when compared with the osteotome.…”

Section: Sample Size and Stopping Criteriamentioning

confidence: 99%

Ultrasonic Bone Scalpel (USBS) Does Not Reduce Blood Loss During Posterior Spinal Fusion (PSF) in Patients with Adolescent Idiopathic Scoliosis (AIS)

Garg

Thomas

Darland

et al. 2021

Spine

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Study Design. Randomized Clinical Trial.Objective. The aim of this study was to compare the efficacy of USBS with standard-of-care surgical instruments during posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS) by evaluating the difference in estimated blood loss per level fused (EBL/level). Summary of Background Data. PSF surgery for AIS is often associated with high blood loss. Use of an ultrasonic bone scalpel (USBS) has been proposed to reduce blood loss during scoliosis surgery. Methods. This was a single-blinded (patient-blinded), randomized, controlled superiority trial. We randomized 66 patients with AIS undergoing PSF to the control group (osteotome) or the experimental group (USBS). The primary outcome was intraoperative EBL/level obtained from red blood cell salvage reports. One-year follow-up was available for 57 of 62 (92%) of patients.Results. EBL/level averaged 35 and 39 mL/level in the experimental and control groups, respectively [adjusted mean difference USBS -osteotome À8 mL/level, 95% CI: À16.4 to 0.3 mL/ level, P ¼ 0.0575]. There was no difference in curve correction [adjusted mean difference: À1.7%, 95% CI: À7.0 to 3.6%, P ¼ 0.5321] or operative time [adjusted mean difference: À3.55 minutes, 95% CI: À22.45 to 15.46 min, P ¼ 0.7089] between groups. Complications requiring change in routine postoperative care were noted in eight patients: two occurred in patients assigned to the experimental group and six occurred in patients assigned to the control group. Conclusions. There was no clinically significant difference in total blood loss, EBL/level, or complications between the two groups. In contrast to reports from other centers, at our highvolume spine center, USBS did not lead to reduced blood loss during PSF for AIS. These results may not be generalizable to centers with longer baseline operative times or higher baseline average blood loss during PSF for AIS.

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Blood Loss Trends and Financial Implications in Adolescent Idiopathic Scoliosis

Cited by 14 publications

References 18 publications

Perioperative Hidden Blood Loss in Elderly Cervical Spondylosis Patients With Anterior Cervical Discectomy Fusion and Influencing Factors

Perioperative Hidden Blood Loss in Elderly Cervical Spondylosis Patients With Anterior Cervical Discectomy Fusion and Influencing Factors

Minimizing Blood Loss in Spine Surgery

Ultrasonic Bone Scalpel (USBS) Does Not Reduce Blood Loss During Posterior Spinal Fusion (PSF) in Patients with Adolescent Idiopathic Scoliosis (AIS)

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