Effects of race on blood loss in spinal fusions for adolescent idiopathic scoliosis

Abstract

OBJECTIVEPosterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can be associated with significant blood loss. It has been suggested that blood loss is greater in different racial groups. The purpose of this study was to evaluate differences in blood loss between African American and Caucasian patients undergoing PSF for AIS.METHODSA retrospective review was performed of patients aged 10–18 years with AIS who were treated with PSF from 2014 to 2017 at a single children’s healthcare system. Patient demographic, radiographic, and operative data were obtained from medical records. Intraoperative blood loss was calculated using the formula described by Waters et al. Patients who declined reporting their race or had prior spinal surgery, neuromuscular or syndromic diagnoses, a history of cardiac or thoracic surgery, or a bleeding disorder were excluded. Blood loss variables were log-transformed for normality and modeled using multivariable linear regression.RESULTSA total of 433 PSFs for AIS qualified for the analysis. The average age was 14.1 years, and 73.7% of the patients were female. With respect to race, 44.6% identified themselves as African American. There was no significant difference in blood loss (p = 0.31) or blood loss per level fused (p = 0.36) in African American patients. African American patients, however, did have significantly lower preoperative hemoglobin and hematocrit levels and greater operating room time than Caucasian patients (p < 0.001). There was no difference between race and transfusion rate.CONCLUSIONSThere appears to be no relationship between race and blood loss during PSF for AIS. Standardized protocols for minimizing perioperative blood loss can be applied to both Caucasian and African American patients.

Racial Disparities in Postoperative Outcomes Following Operative Management of Pediatric Developmental Dysplasia of the Hip

“…Multivariate analysis was not performed on these variables, however, and the cohorts did not significantly differ in age, height, weight, body mass index, or sex. This study also did not look at the prevalence of other comorbid conditions 27…”

“…These studies investigated hospitalization rate for septic arthritis, rate of implant removal after internal fixation of femoral shaft fractures, and postoperative outcomes following posterior spinal fusion. [25][26][27] The study investigating the rate of hospitalization for septic arthritis found that White and African American children had increased rates of hospitalization for septic arthritis in comparison to the Asian and Hispanic pediatric patients. 26 Dodwell and colleagues examined the rate of implant removal, including, plates, screws, and intramedullary nails, following internal fixation of femoral shaft fractures.…”

“…This study also did not look at the prevalence of other comorbid conditions. 27 Among these studies, there have not been any investigations into time to extubation or rates of unplanned reintubation following operative management of pediatric patients. On the basis of a study looking at adult risk factors for unplanned reintubation, an ASA status of III was determined to be one of the risk factors leading to acute airway compromise and unplanned reintubation.…”

“…There is a paucity of published data investigating the relationship between race and postoperative outcomes after pediatric orthopaedic surgery, but several studies do exist. These studies investigated hospitalization rate for septic arthritis, rate of implant removal after internal fixation of femoral shaft fractures, and postoperative outcomes following posterior spinal fusion 25–27. The study investigating the rate of hospitalization for septic arthritis found that White and African American children had increased rates of hospitalization for septic arthritis in comparison to the Asian and Hispanic pediatric patients 26.…”

“…Consequently, the authors of this study proposed that optimizing fee schedules for lower reimbursement programs could potentially help reduce the discrepancy. 25 Kaushal et al 27 specifically investigated blood loss during posterior spinal fusion and found that there was no significant difference in blood loss when comparing African American to White pediatric patients when adjusting for demographic data using multivariable regression. This study did show that African American children did have lower preoperative hemoglobin and hematocrit as well as a longer overall operating room time on univariate analysis.…”