Søren Ohrt-Nissen1, Naeem Bukhari1, Casper Dragsted1, Martin Gehrchen1, Pär I Johansson2, Jesper Dirks3, Jakob Stensballe3,2, Benny Dahl4. 1. Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 2. Section for Transfusion Medicine, Rigshospitalet, Capitol Region Blood Bank, Copenhagen, Denmark. 3. Department of Anesthesiology, Center of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 4. Division of Orthopedic Surgery, Texas Children's Hospital, Houston, Texas.
Abstract
BACKGROUND: The surgical treatment of adolescent idiopathic scoliosis can be associated with substantial blood loss, requiring allogeneic red blood cell (RBC) transfusion. This study describes the use of RBC and the effect of a standardized perioperative patient blood management program. STUDY DESIGN AND METHODS: Patients treated with posterior instrumented fusion were consecutively enrolled over a 6-year period. Patient blood management strategies were implemented in 2011, including prophylactic tranexamic acid, intraoperative permissive hypotension, restrictive fluid therapy (including avoidance of synthetic colloids), restrictive RBC trigger according to institutional standardized protocol, the use of cell savage, and goal-directed therapy according to thrombelastography. RESULTS: In total, 210 patients were included. 64 patients (31%) received RBC transfusions. A decline in the intraoperative rate of RBC transfusion was observed, from 77% in 2011 to 13% in 2016 (p < 0.001). Patients in the transfusion group had a significantly larger major curve, lower preoperative hemoglobin, higher estimated blood loss, and an increased use of crystalloid volume resuscitation. Multiple logistic regression showed that significant predictors for RBC transfusion were preoperative hemoglobin level (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.27-0.57), estimated blood loss (OR, 1.26; 95% CI, 1.15-1.42), and year of surgery (indicating the effect of patient blood management) (OR per year, 0.76; 95% CI, 0.58-0.99). CONCLUSION: A perioperative patient blood management program substantially reduced the need for RBC transfusion. A preoperative evaluation of anemia is essential to further minimize transfusion rates.
BACKGROUND: The surgical treatment of adolescent idiopathic scoliosis can be associated with substantial blood loss, requiring allogeneic red blood cell (RBC) transfusion. This study describes the use of RBC and the effect of a standardized perioperative patient blood management program. STUDY DESIGN AND METHODS: Patients treated with posterior instrumented fusion were consecutively enrolled over a 6-year period. Patient blood management strategies were implemented in 2011, including prophylactic tranexamic acid, intraoperative permissive hypotension, restrictive fluid therapy (including avoidance of synthetic colloids), restrictive RBC trigger according to institutional standardized protocol, the use of cell savage, and goal-directed therapy according to thrombelastography. RESULTS: In total, 210 patients were included. 64 patients (31%) received RBC transfusions. A decline in the intraoperative rate of RBC transfusion was observed, from 77% in 2011 to 13% in 2016 (p < 0.001). Patients in the transfusion group had a significantly larger major curve, lower preoperative hemoglobin, higher estimated blood loss, and an increased use of crystalloid volume resuscitation. Multiple logistic regression showed that significant predictors for RBC transfusion were preoperative hemoglobin level (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.27-0.57), estimated blood loss (OR, 1.26; 95% CI, 1.15-1.42), and year of surgery (indicating the effect of patient blood management) (OR per year, 0.76; 95% CI, 0.58-0.99). CONCLUSION: A perioperative patient blood management program substantially reduced the need for RBC transfusion. A preoperative evaluation of anemia is essential to further minimize transfusion rates.
Authors: Lisa Eisler; Stanford Chihuri; Lawrence G Lenke; Lena S Sun; David Faraoni; Guohua Li Journal: Transfusion Date: 2021-11-10 Impact factor: 3.157
Authors: Alexander Mihas; Subaraman Ramchandran; Sebastian Rivera; Ali Mansour; Jahangir Asghar; Harry Shufflebarger; Stephen George Journal: BMC Musculoskelet Disord Date: 2021-02-19 Impact factor: 2.362