Spine Surgery and Blood Loss: Systematic Review of Clinical Evidence

Willner, Dafna; Spennati, Valeria; Stohl, Shelly; Tosti, Giulia; Aloisio, Simone; Bilotta, Federico

doi:10.1213/ane.0000000000001485

Cited by 61 publications

(34 citation statements)

References 39 publications

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“…Studies assessing restrictive and liberal blood transfusion protocols have investigated the impact of transfusion on health care outcomes, as well as strategies to decrease transfusion requirements. 1 These methods include preoperative cessation of antiplatelet and anticoagulation medication; intraoperative considerations such as cell salvage, anesthetic management, and use of antifibrinolytic agents (eg, tranexamic acid); surgical technique; and postoperative considerations of surgical drain placement and choice of analgesic. 16 There are several limitations of this singleinstitution retrospective cohort study.…”

Section: Discussionmentioning

confidence: 99%

“…Spine surgery is associated with significant intraoperative blood loss, often resulting in transfusion. Willner et al 1 completed a systematic review that assessed both pharmacologic and nonpharmacologic factors used to reduce intraoperative blood loss and subsequent transfusion. It has been shown that blood transfusions prolong hospital length of stay, increase postoperative complications, and increase 30-day return to the operating room.…”

Section: Introductionmentioning

confidence: 99%

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Institution-Wide Blood Management Protocol Reduces Transfusion Rates Following Spine Surgery

et al. 2019

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Background: Spine surgery is associated with significant intraoperative blood loss, often leading to transfusion. Patients who receive transfusions have an increased length of stay and risk of perioperative complications. To decrease the transfusion rate, we implemented an evidence-based institution-wide restrictive transfusion blood management guideline. The goal of this study is to describe the impact of this guideline on our spine surgery patients. Methods: We analyzed the incidence of transfusion following 3709 single-institution, inpatient spine procedures before and after implementation of a revised blood transfusion protocol. The baseline period (1742 patients) from January 2014 to March 2015 was compared to the study period (1967 patients) of April 2015 to July 2016. One patient was excluded because of incomplete medical records. The revised protocol included establishing a postoperative blood transfusion trigger at hemoglobin , 7g/dL, instituting a computerized provider order entry, and appointing a physician champion to monitor and report progress. Results: Transfusion rate decreased from 16.2% to 9.7% from baseline to study period, respectively (P , .001). The number of transfusions in patients with hemoglobin. 7g/dL decreased to 4.9% from 6.1% (P ¼ .09). The rate of transfusions with a prior hemoglobin test increased from 42.0% to 59.1% (P , .001). Length of stay was reduced from 3.67 to 3.46 days (P ¼ .04), and postsurgical infection rate was reduced from 1.5% to 0.6% (P ¼ .01). There was no significant difference in total hospital costs following protocol implementation. Conclusions: Implementation of a restrictive transfusion protocol through use of a computerized provider order entry and a physician champion to oversee clinician compliance led to a 40.1% reduction in blood transfusion following spine surgery. Behavior changes were visible with a 40.7% increase in hemoglobin documentation before transfusion, and patients benefited from a reduction in length of stay and postsurgical infection rate. Future study is encouraged to understand the long-term impact of this intervention and its role in hospital expenditure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Institution-Wide Blood Management Protocol Reduces Transfusion Rates Following Spine Surgery

et al. 2019

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“…Особенно это характерно для одномоментной экстирпации аномально развитого позвонка из бокового люмботомического доступа и фиксации металлоконструкцией из дорсального подхода. Интраоперационная кровопотеря в таких ситуациях может достигать 80 % и более объема циркулирующей крови [8]. [9][10][11][12][13].…”

Section: обоснованиеunclassified

Comparative evaluation of options for postoperative analgesia during surgical correction of congenital spine deformity in children

Kozyrev

Сергеевич²,

Zaletina

et al. 2019

Pediatr Traum Orthop Reconstr Surg

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Background. In the planning of anesthesia and postoperative therapy for surgical correction of congenital spinal deformity, the volume, the spine that is operated, and the patients age are all factors to consider. In pediatric practice, the use of opioid analgesics for pain relief in the postoperative period after extensive and traumatic surgical interventions is generally accepted. There is very little information on the effectiveness and safety of prolonged epidural analgesia in young children in spinal surgery. Aim. The aim of this study was to give a comparative assessment of the use of prolonged epidural blockade and constant drip of fentanyl as the main components of postoperative analgesia during surgical correction of congenital spine deformity caused by violation of the vertebra formation in children. Materials and methods. The features of the postoperative period in 43 cases of correction of congenital spine curvature performed in the Turner Scientific Research Institute for Childrens Orthopedics from 2016 to 2018 were retrospectively evaluated. Patient age ranged from 2 to 11 years. The patients were divided into two groups: group P included 22 patients whose main component of postoperative anesthesia was prolonged epidural analgesia, and group F included 21 patients whose main component of postoperative anesthesia was fentanyl. Anamnestic data analysis and clinical, laboratory, instrumental, and statistical analyses were used as methods of assessment. Results. The data showed that the number of patients with undesirable respiratory disorders recorded in the first day in the form of bradypnea and desaturation was higher in group F than in group P. The number of patients who experienced nausea and vomiting and those who received antiemetics on the first day after surgery were comparable in both groups. However, the number of patients with fixed nausea, vomiting, and receiving antiemetics became significantly higher in group F in the next 2 days. In addition, at all stages of the assessment, there was an increase in the recorded episodes of peristalsis inhibition in patients from group F. The number of patients, who required additional anesthesia within 3 days of observation was comparable in both groups. Conclusion. Prolonged epidural analgesia and constant drip of fentanyl are equally effective for providing pain relief in the postoperative period, but prolonged epidural analgesia provides a significant reduction in the frequency and severity of the gastrointestinal tract dysfunction.

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“…Спинальная нейрохирургия. За последние 15 лет частота выполненных в мире спинальных нейрохирургических вмешательств выросла на 220% [85]. Спинальная нейрохирургия -вторая по частоте среди нейрохирургических вмешательств после хирургии ЧМТ и в России, и в мире.…”

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“…Кровопотеря в спинальной нейрохирургии остается одной из ключевых проблем. Так, объем кровопотери при комбинированных передних и задних доступах, а также при удалении первичных и метастатических опухолей типа «песочных часов» составляет в среднем 6-10 л [85]. В серии исследований было показано, что применение rFVIIa в ходе спинальных вмешательств с целью достижения гемостаза достоверно уменьшает объем операционной кровопотери (на 54-86%) и соответственно объем расходуемых донорских трансфузионных сред (на 81-95%) [86].…”

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The use of activated recombinant factor VII in neurosurgery

Lubnin

2018

Vopr. neirokhir.

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Список сокращений: ВМК-внутримозговое кровоизлияние КТ-компьютерная томография РКИ-рандомизированное контролируемое исследование САК-субарахноидальное кровотечение СМП-свежезамороженная плазма ЧМТ-черепно-мозговая травма

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Spine Surgery and Blood Loss: Systematic Review of Clinical Evidence

Cited by 61 publications

References 39 publications

Institution-Wide Blood Management Protocol Reduces Transfusion Rates Following Spine Surgery

Institution-Wide Blood Management Protocol Reduces Transfusion Rates Following Spine Surgery

Comparative evaluation of options for postoperative analgesia during surgical correction of congenital spine deformity in children

The use of activated recombinant factor VII in neurosurgery

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