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

Liu, Haonan; Li, Duoyi; Zhang, Xuejun; Qi, Xinyu; Guo, Dong; Bai, Yunsong; Tian, Muyang

doi:10.1097/bpb.0000000000000975

Cited by 5 publications

(7 citation statements)

References 25 publications

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“…The literature regarding HBL in congenital scoliosis, surgery is limited. Recently, Liu et al reported that HBL accounted for 41% of total blood loss in their series with 108 paediatric patients undergoing posterolateral hemivertebrectomy and posterior instrumentation [ 26 ]. Their mean total blood loss of 575 ml was also in line with the results of the current study as we observed a mean total blood loss of 648 ml in the hemivertebrectomy patients.…”

Section: Discussionmentioning

confidence: 99%

“…Since then, several studies have demonstrated that HBL constitutes a significant part of the total postoperative bleeding also in spinal fusion for scoliosis [ 16 , 17 , 22 , 25 ]. Recently, Liu et al reported that HBL accounted for over 40% of total blood loss in posterior hemivertebra resection for congenital scoliosis [ 26 ]. Hemivertebrectomy and posterior VCR are performed by an extracavitatory approach using costotransversectomy and an extra-pleural approach to enable a safe approach around the spine for osteotomy.…”

Section: Introductionmentioning

confidence: 99%

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Hidden blood loss and bleeding characteristics in children with congenital scoliosis undergoing spinal osteotomies

Raitio,

Heiskanen,

Soini

et al. 2024

International Orthopaedics (SICOT)

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Purpose Spinal osteotomies are often essential in the treatment of congenital scoliosis. Risk factors for bleeding in these patients needing extracavitatory approaches, especially hidden blood loss, are sparsely investigated. We aimed to investigate the bleeding characteristics and hidden blood loss in paediatric patients undergoing spinal osteotomies for congenital scoliosis. Methods A retrospective analysis identified all patients with congenital scoliosis were retrospectively identified from the prospectively collected spine register from 2010 to 2022. Operative technique, perioperative laboratory results and imaging studies were extracted. The primary outcome was total blood loss including intraoperative, drain output and hidden blood loss. Results Fifty-seven children (32 boys) with a mean age of 8.3 years underwent spinal osteotomy for congenital scoliosis. Posterolateral hemivertebrectomy was sufficient in 34 (59%) patients, while vertebral column resection (VCR) was required in 23 patients. Total bleeding averaged 792 (523) ml accounting for 42% of the estimated blood volume. Hidden blood loss accounted for 40% of total bleeding and 21% of estimated blood volume with a mean of 317 (256) ml. VCR was associated with greater intraoperative and total bleeding than hemivertebrectomies (p = 0.001 and 0.007, respectively). After adjusting for patient weight and fusion levels, hidden blood loss was larger in hemivertebrectomies (4.18 vs. 1.77 ml/kg/fused level, p = 0.049). In multivariable analysis, intraoperative blood loss was inversely correlated with preoperative erythrocyte levels. Younger age was associated with significantly greater drain, hidden and total blood loss. Conclusion Hidden blood loss constitutes a significant portion (40%) of total bleeding in congenital scoliosis surgery. Younger age is a risk factor for bleeding and the hidden blood loss should be taken into consideration in their perioperative management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hidden blood loss and bleeding characteristics in children with congenital scoliosis undergoing spinal osteotomies

Raitio,

Heiskanen,

Soini

et al. 2024

International Orthopaedics (SICOT)

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“…Adolescent idiopathic scoliosis (AIS) is a common spinal deformity, and posterior instrumentation and fusion is a common method for treating AIS [ 1 ]. However, the operation is complicated and causes massive intraoperative blood loss (650–2,839 mL) [ 2 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

A cost-effectiveness analysis of intraoperative autologous transfusion in adolescent idiopathic scoliosis surgery: a single-centre retrospective study

Chi

Luo

et al. 2023

BMC Anesthesiol

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Background Intraoperative autologous transfusion (IAT) has been used in scoliosis surgery for decades; however, its cost-effectiveness remains debatable. This study aimed to evaluate the cost-effectiveness of IAT in adolescent idiopathic scoliosis (AIS) surgery and identify risk factors of massive intraoperative blood during this surgery. Methods The medical records of 402 patients who underwent AIS surgery were reviewed. The patients were divided into different groups according to the intraoperative blood loss volume (group A: ≥500 to < 1000 mL, B: ≥1,000 to < 1,500 mL, and C: ≥1,500 mL) and whether IAT was used (i.e., IAT and no-IAT groups). The volume of blood loss, volume of transfused allogeneic red blood cells (RBC), and RBC transfusion costs were analysed. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors of massive intraoperative blood loss (≥ 1,000 mL and ≥ 1,500 mL). A receiver operating characteristic (ROC) curve was used to analyse the cut-off values of the factors contributing to massive intraoperative blood loss. Results In group A, no significant difference was observed in the volume of allogeneic RBC transfused during and after procedure between the IAT and no-IAT groups; however, total RBC transfusion costs was significantly higher in the IAT group. In groups B and C, the patients in the IAT group compared with those in the no-IAT group had a lower volume of allogeneic RBC transfused during the operation and on the first day after the operation. However, in group B, the total RBC transfusion cost in the patients who used IAT was significantly higher. In group C, total RBC transfusion cost in the patients who used IAT was significantly lower. The number of fused vertebral levels and Ponte osteotomy were found to be independent risk factors for massive intraoperative blood loss. ROC analysis showed that more than eight and 10 fused vertebral levels predicted ≥ 1,000 mL and ≥ 1,500 mL intraoperative blood loss, respectively. Conclusion The cost-effectiveness of IAT in AIS was related to the volume of blood loss, and when the blood loss volume was ≥ 1,500 mL, IAT was cost-effective, drastically reducing the demand for allogeneic RBC and total RBC transfusion cost. The number of fused vertebral levels and Ponte osteotomy were independent risk factors for massive intraoperative blood loss.

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“…However, the operation is complicated and causes massive intraoperative blood loss (650-2,839 mL) [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

A Cost-Effectiveness Analysis Of Intraoperative Autologous Transfusion In Adolescent Idiopathic Scoliosis Surgery: A Single-center Retrospective Study

Chi

Luo

et al. 2023

Preprint

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Background: Intraoperative autologous transfusion(IAT) has been used in scoliosis surgery for decades; however, its cost-effectiveness remains debatable. Therefore, this study aimed to evaluate the cost-effectiveness of IAT in adolescent idiopathic scoliosis (AIS) surgery with different blood loss volumes. Methods: The medical records of 402 patients who underwent AIS surgery were reviewed. Depending on the volume of blood lost during the operation, the patients were divided into three groups: A (≥500 to <1000 mL), B (≥1,000 to <1,500 mL), and C (≥1,500mL). Depending on whether IAT was used, each group was further divided into the IAT and no-IAT groups. The volume of blood loss, volume of transfused allogeneic red blood cells (RBC),and RBC transfusioncosts were analyzed.Univariate and multivariate logistic regression analyses were used to identify the independent risk factors of massive intraoperative blood loss (≥1,000 mL and ≥1,500 mL). A receiver operating characteristic (ROC) curve was used to analyze the cutoff values of the factors contributing to massive intraoperative blood loss. Results: In group B, the IAT group had a lower volume of allogeneic RBC transfused than the no-IAT group, whereas the total RBC transfusion cost in the IAT group was significantly higher than that in the no-IAT group. In group C, the volume of allogeneic RBC transfused in the IAT group reduced significantly more than that in the no-IAT group. The number of vertebral levels fused was found to be an independent risk factor for massive intraoperative blood loss. Conclusion: The cost-effectiveness of IAT in AIS is related to the volume of blood lost. The number of fused vertebral levels is an independent risk factor that can effectively predict massive intraoperative blood loss.

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

Cited by 5 publications

References 25 publications

Hidden blood loss and bleeding characteristics in children with congenital scoliosis undergoing spinal osteotomies

Hidden blood loss and bleeding characteristics in children with congenital scoliosis undergoing spinal osteotomies

A cost-effectiveness analysis of intraoperative autologous transfusion in adolescent idiopathic scoliosis surgery: a single-centre retrospective study

A Cost-Effectiveness Analysis Of Intraoperative Autologous Transfusion In Adolescent Idiopathic Scoliosis Surgery: A Single-center Retrospective Study

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