Value in Scoliosis Surgery: Coordinated Surgical and Anesthetic Techniques Avoid Blood Transfusion without Fibrinolytic Medications or Red Blood Cell Salvage

Abstract

Study design: Retrospective chart review.

Objective: The aim of this study was to document the impact of coordinated surgical and anesthetic techniques on estimated blood loss (EBL) and subsequent need for transfusion.

Summary of background data: Scoliosis surgery is typically associated with large quantities of blood loss, and consequently blood transfusion may be necessary. Many strategies have been employed to minimize blood loss, including blood collection with reinfusion ("cell-saver") and the use of antifibrinolytic drugs. We reviewed our experience with methods to minimize blood loss to show that transfusion should be a rare event.

Methods: One hundred and thirty consecutive cases of spine fusion for adolescent idiopathic scoliosis utilizing pedicle screw fixation were reviewed from March 2013 to October 2019. The senior author was the primary surgeon for all cases. Data were collected from the electronic medical record, including age, sex, weight, number of instrumented levels, EBL, total fluids administered during surgery, pre- and postoperative hemoglobin, and procedure duration.

Results: The average EBL was 232 ± 152 mL (range 37-740 mL). The average preoperative hemoglobin was 13.4 ± 1.2 g/dL and the average postoperative hemoglobin (last measured before discharge) was 9.0 ± 1.2 g/dL. One patient received a transfusion of 270 mL homologous blood. Blood salvage and reinfusion ("cell-saver") was not used. No patient was managed with antifibrinolytic drugs.

Conclusion: Minimizing blood loss using a combination of surgical and anesthesia techniques can effectively eliminate the need for blood transfusion. The elimination of costly adjuncts increases the value of a complex orthopedic procedure.Level of Evidence: 5.