Effect of intraoperative autologous transfusion techniques on perioperative hemoglobin level in idiopathic scoliosis patients undergoing posterior spinal fusion: A prospective randomized trial

Abstract

Background: Massive blood loss during posterior spinal fusion for adolescent idiopathic scoliosis remains a significant risk for patients. There is no consensus on the benefit of acute normovolemic hemodilution (ANH) or intraoperative cell salvage (ICS) in scoliosis surgery. Methods: Patients were randomized to one of two groups. Group A received ANH and ICS during operation, while group B received only ICS. Patients' age, sex, height, weight, body blood volume, number of fusion level, Cobb angle, number of screws, duration of surgery, and skin incision length were recorded. Hemoglobin and hematocrit levels were obtained preoperatively and postoperatively (0 h and 24 h). Results: There were 22 patients in each group. There was no significant difference in total blood loss. The perioperative decrease in hemoglobin levels between preoperation and postoperation 24 h (group A 2.79 + 1.15 and group B 2.76 + 1.00) showed no significant difference (p ¼ 0.93). Group A observed a larger decrease in hemoglobin levels at postoperative 0 h relative to preoperative level (2.57 + 0.82 g/dl), followed by a smaller decrease within the next 24 h (0.22 + 1.33 g/dl). Group B showed a continued drop in hemoglobin levels of similar magnitude at postoperation 0 h (1.60 + 0.67 g/dl) and within the next 24 h (1.16 + 0.78 g/dl). One patient from group B received 1 unit of allogenic blood transfusion (p ¼ 0.33). Conclusions: The addition of ANH to ICS in posterior spinal fusion surgery for AIS resulted in a similar decrease in hemoglobin levels between preoperative values and at 24 h postoperatively.

The efficacy and safety of intraoperative acute normovolaemic haemodilution in complex spine surgery in a private surgical facility in Ghana

“…Consistent with our findings, a previous experimental study by Hasan et al 11 showed that ANH does not provide significant additional benefits when combined with intraoperative cell salvage (ICS). The congruency in findings may be explained by similarity in aetiology, degree of surgical blood loss, and levels of spine fusion in both studies.…”

“…Our finding on safety of ANH was in agreement with previous studies which have reported that the utilization of ANH is safe in spine deformity surgery. [9][10][11] Our findings indicate that for severe spine deformity patients who are candidates for corrective spinal surgery but have personal, religious and cultural reservations for allogeneic blood transfusion, care should be taken as allogeneic blood transfusions may be inevitable for their complex surgeries despite the use of ANH. For these patients, we would recommend that in addition to the intraoperative blood conservation techniques their surgeries be staged to allow adequate time to replenish blood loss and Hb prior to their final surgery.…”

“…Although there is a growing literature on the use of ANH in spine surgery 2,[9][10][11] , its efficacy, safety and cost effectiveness in complex spine deformity surgeries has not been adequately studied in underserved regions such as West Africa. Given the paucity of literature on the efficacy and safety of the utilization of ANH as a blood conservation method in complex spine surgery in the developing world, the present study sought to investigate the safety and efficacy of ANH and associated transfusion related complications in complex spine surgery in a private orthopaedic hospital in Ghana.…”

Papel da hemodiluição normovolêmica aguda na taxa de transfusão de sangue homólogo nos pacientes submetidos a tratamento cirúrgico de escoliose

“…A HNA tem sua indicação de uso nos casos em que a perda cirúrgica antecipada é maior que um litro ou 20% do volume sanguíneo (OPPITZ; STEFANI, 2013;ZAUDER, 1991 (IALENTI et al, 2013;LI et al, 2014LI et al, , 2015MARKS et al, 2007;YU et al, 2013) e os relacionados à cirurgia, como número de níveis de fusão, tempo operatório, estágios da cirurgia, número de osteotomias e abordagem cirúrgica anterior ou posterior (DOI et al, 2011;IALENTI et al, 2013;GUAY et al, 1994;KOERNER et al, 2014;LI et al, 2015;MODI et al, 2010;YOSHIHARA;YONEOKA, 2014;YU et al, 2013 No presente estudo, para tentar estabelecer a influência do procedimento cirúrgico nas taxas de transfusões sanguíneas, alguns dos fatores citados foram avaliados, pois já se demonstrou correlação positiva com a perda total de sangue e a presença desses fatores (HASAN et al, 2017).…”

“…O retorno do sangue coletado do paciente ao término do procedimento cirúrgico deve restaurar os valores de hemoglobina e aumentar os fatores de coagulação e as concentrações de plaquetas, reduzindo o sangramento e a necessidade de transfusão sanguínea alogênica (DUGUID,1999;NAPIER et al, 1997). Hasan et al (2017), em um estudo prospectivo e randomizado em 44 pacientes submetidos à artrodese de coluna via posterior, compararam os níveis de hemoglobina no perioperatório em pacientes que realizaram a HNA e a recuperação intraoperatória de sangue com pacientes que só realizaram a técnica de recuperação intraoperatória de sangue. Não foi observada, entre os grupos, diferença estatisticamente significante nos valores de hemoglobina e hematócrito no pósoperatório imediato e pós-operatório tardio (24 horas depois).…”