Predicting massive transfusion in adolescent idiopathic scoliosis patients undergoing corrective surgery

Abstract

Corrective surgery with a posterior approach for adolescent idiopathic scoliosis (AIS) is often accompanied by considerable bleeding. Massive transfusion after excessive hemorrhage is associated with complications such as hypothermia, coagulopathy, and acid-base imbalance. Therefore, prediction and prevention of massive transfusion are necessary to improve the clinical outcome of AIS patients. We aimed to identify the factors associated with massive transfusion in AIS patients undergoing corrective surgery. We also evaluated the clinical outcomes after massive transfusion.We included and analyzed AIS patients who underwent corrective surgery with a posterior approach from January 2008 to February 2015. We retrospectively reviewed the electronic medical records of 765 consecutive patients. We performed multivariable logistic regression analysis to assess the factors related to massive transfusion. Furthermore, we compared the effects of massive transfusion on clinical outcomes, including postoperative morbidity and hospital stay.Of 765 patients, 74 (9.7%) received massive transfusion. Body mass index (odds ratio [OR] 0.782, 95% confidence interval [CI] 0.691-0.885, P < .001) and the number of fused vertebrae (OR 1.322, 95% CI 1.027-1.703, P = .03) were associated with massive transfusion. In the comparison among the different Lenke curve types, Lenke type 4 showed the highest prevalence of massive transfusion. Patients in the massive transfusion group showed a higher incidence rate of postoperative morbidity and prolonged hospital stay.Massive transfusion was required in 9.7% of AIS patients who underwent corrective surgery with a posterior approach. A lower body mass index and higher number of fused vertebrae were associated with massive transfusion. Massive transfusion is related to poor clinical outcomes in AIS patients.

Predictors of perioperative blood loss in primary posterior hemivertebra resection for pediatric patients with congenital scoliosis

“…In the present study, we found similar predictors of visible loss for congenital scoliosis, including preoperative Cobb angle, operative time, and number of fused levels. Many studies on visible loss focused on AIS, and most of them reported that age was not related to intraoperative bleeding [6,11,17]. In contrast, we found that age was a significant factor correlated with operative blood [11,17].…”

High- versus low-dose tranexamic acid as part of a Patient Blood Management strategy for reducing blood loss in patients undergoing surgery for adolescent idiopathic scoliosis

“…Bleeding during surgery for adolescent idiopathic scoliosis (AIS) can be substantial with average blood loss reported to be between 750–1,500 cc, and up to 9.7% of patients requiring massive transfusion (transfusion of >100% total blood volume within 24 hours) [ 1 – 2 ]. Furthermore, data from the Pediatric Perioperative Cardiac Arrest Registry showed that spine surgery is one of the most at-risk surgery types for perioperative cardiac arrest, accounting for 41% of all arrests.…”

Prediction of perioperative transfusions using an artificial neural network

“…Bleeding and transfusion prediction models have been developed in a number of specialties, including trauma [75], orthopedic surgery [76,77], cardiac surgery [78,79], vascular surgery [80], liver transplantation [81], and otolaryngology [82]. Our study is unique in that rather than assessing transfusion need for a single type of operation, we can do it across a broad spectrum of operation types.…”