Predicting excessive hemorrhage in adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion

Thompson, Mark E.; Kohring, Jessica M.; McFann, Kim; McNair, Bryan; Hansen, Jennifer; Miller, Nancy H.

doi:10.1016/j.spinee.2013.08.022

Cited by 41 publications

(42 citation statements)

References 17 publications

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“…First of all, the extent of fusion levels is an influencing factor of massive blood loss, and this factor is consistent with previous studies. [4,23,24] More fusion levels mean more muscle and soft tissue stripping from vertebrae. Although the use of absorbable gelatin sponge and techniques such as firm packing and electrocautery could minimize intraoperative blood loss that derived from the surfaces of muscle and from vertebrae bleeding, the extent of fusion levels had a positive correlation with blood loss (Pearson correlation r value = 0.314, P = 0.001, data not listed).…”

Section: Discussionmentioning

confidence: 99%

Incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with neuromuscular scoliosis

Jia

Li²,

Xu³

et al. 2017

Medicine

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Factors influencing massive blood loss for neuromuscular scoliosis (NMS) patients.Despite advances in surgical and anesthetic techniques, scoliosis surgery is still associated with intraoperative massive blood loss, which can result in postoperative mortality and morbidity. The aim of this study was to assess the incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with NMS.A retrospective review of adolescents who underwent posterior spinal instrumentation and fusion for NMS was performed. Perioperative variables and data were recorded. Massive blood loss was defined as an estimated blood loss that exceeds 30% of total blood volume.We obtained data for 114 patients, of whom 63 (55%) had intraoperative massive blood loss. Compared with those without, patients with massive blood loss were more likely to be older, have lower body mass indexes (BMIs), larger Cobb angles, more fused levels, more osteotomy procedures, and prolonged duration of operation. Logistic regression analysis identified the number of fused levels to be more than 12 (P = 0.003, odds ratio = 6.614, 95% confidence interval [CI]: 1.891–23.131), BMI lower than 16.8 kg/m2 (P = 0.025, odds ratio = 3.293, 95% CI: 1.159–9.357), age greater than 15 years (P = 0.014, odds ratio = 3.505, 95% CI: 1.259–9.761), and duration of operation longer than 4.4 hours (P = 0.016, odds ratio = 3.746, 95% CI: 1.428–9.822) as influencing factors. Patients with massive blood loss are associated with more intraoperative colloids infusion and blood transfusions (red blood cell and fresh frozen plasma), as well as postoperative drainage volume.In adolescents with NMS who underwent posterior spinal instrumentation and fusion operations, intraoperative massive blood loss is common. The number of fused levels, BMI, age, and duration of operation are factors influencing intraoperative massive blood loss.

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Section: Discussionmentioning

confidence: 99%

Incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with neuromuscular scoliosis

Jia

Li²,

Xu³

et al. 2017

Medicine

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“…A recent study found that massive blood loss, defined as >30% of circulating volume lost, occurred in approximately 60% of patients undergoing scoliosis surgery 8 ; another study, using a large national database, found that almost 30% of patients with adolescent idiopathic scoliosis who had undergone spinal arthrodesis in the last decade received some type of blood transfusion in the perioperative period 11 . Numerous studies have focused on factors such as patient diagnosis, sex, number of levels fused, operative time, and curve magnitude [2][3][4][5][6][7][8][9] . However, to our knowledge, the relationship between patient size (measured via blood volume) and blood loss has not previously been described.…”

Section: Discussionmentioning

confidence: 99%

“…Factors such as patient diagnosis [2][3][4] , sex 5 , number of levels fused 4,6-8 , operative time 5,7 , and coronal 7-9 and sagittal-curve magnitude 5 have been shown to be associated with intraoperative blood loss.…”

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confidence: 99%

Smaller Body Size Increases the Percentage of Blood Volume Lost During Posterior Spinal Arthrodesis

Jain

Sponseller

Newton³

et al. 2015

The Journal of Bone and Joint Surgery

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“…Factors associated with blood loss in PSF for scoliosis or kyphosis have been investigated mostly in retrospective studies . These studies have implicated the following patient and surgical risk factors for blood loss: Cobb angle >50°, female gender, African American race, anemia, known bleeding disorders, abnormal coagulation profiles, neuromuscular scoliosis, operative time, posterior lumbar fusion, number of levels fused, and use of Ponte osteotomies . Ryan and colleagues found that children with scoliosis have a high prevalence of abnormalities in screening coagulation laboratory tests obtained preoperatively compared with healthy patients, primarily the prothrombin time .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] These studies have implicated the following patient and surgical risk factors for blood loss: Cobb angle >50°, female gender, African American race, anemia, known bleeding disorders, abnormal coagulation profiles, neuromuscular scoliosis, operative time, posterior lumbar fusion, number of levels fused, and use of Ponte osteotomies. [2][3][4][5][6][7][8][9][10][11][12] Ryan and colleagues found that children with scoliosis have a high prevalence of abnormalities in screening coagulation laboratory tests obtained preoperatively compared with healthy patients, primarily the prothrombin time. 2 Although the etiologies of these coagulation abnormalities were not elucidated, factor X levels in this study were lower in scoliosis patients than healthy controls.…”

Section: Introductionmentioning

confidence: 99%

Coagulative function assessed preoperatively via the clot formation and lysis assay as a prognostic factor for blood loss in adolescents undergoing posterior spinal fusion for idiopathic scoliosis

Fernández

Neustadt

Hahn

et al. 2019

Pediatric Anesthesia

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Background Posterior spinal fusion for adolescent idiopathic scoliosis is a complex surgery often associated with clinically significant blood loss leading to perioperative blood transfusion. Knowledge of risk factors for blood loss and transfusion stems mostly from retrospective studies. Aim We sought to prospectively investigate putative prognostic factors for intraoperative blood loss and perioperative blood transfusion in adolescent idiopathic scoliosis patients undergoing posterior spine fusion, including clinical characteristics, surgical factors, and preoperative assessment of overall coagulative and fibrinolytic functions in plasma using the clot formation and lysis (CloFAL) assay. Methods Following Internal Review Board approval, adolescents 10 to <21 years old with idiopathic scoliosis undergoing posterior spine fusion were enrolled preoperatively in a single‐institutional prospective cohort and biobanking study. Clinical data were collected on patient characteristics, surgical approach, perioperative management, intraoperative estimated blood loss, and blood transfusion through hospital discharge. Coagulative and fibrinolytic functions in plasma were measured on preoperative samples by CloFAL assay (Coagulation Index and modified Fibrinolytic Index). Univariate linear regression and multivariable linear regression were performed to identify predictors of weight‐indexed intraoperative estimated blood loss EBL (EBL/kg). Results The final study population included 74 patients. Median age was 14.8 years (SD = 2.2). After adjustment for other putative prognostic factors via multivariable linear regression, coagulative function as determined preoperatively by CloFAL Coagulation Index was an independent predictor of intraoperative (EBL)/kg. Specifically, each 10% increase in CloFAL CI was associated with 3% decrease in the geometric mean of EBL/kg (OR 0.97, 95%CI 0.94‐0.99, P = .01). Conclusion In adolescents undergoing posterior spinal fusion for idiopathic scoliosis, increased coagulative function measured preoperatively using the CloFAL assay is independently associated with decreased intraoperative blood loss. Future studies should expand upon these investigations of plasma coagulative and fibrinolytic capacities in combination with clinical factors, to guide precise preventive strategies against blood loss and blood transfusion in this patient population.

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Predicting excessive hemorrhage in adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion

Cited by 41 publications

References 17 publications

Incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with neuromuscular scoliosis

Incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with neuromuscular scoliosis

Smaller Body Size Increases the Percentage of Blood Volume Lost During Posterior Spinal Arthrodesis

Coagulative function assessed preoperatively via the clot formation and lysis assay as a prognostic factor for blood loss in adolescents undergoing posterior spinal fusion for idiopathic scoliosis

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