Blood management strategies in posterior corrective surgery for idiopathic scoliosis

Abstract

Background: Corrective surgery for adolescent idiopathic scoliosis (AIS) is associated with large volumes of blood loss and a need for blood transfusion. Our study aim was to measure blood loss and blood products used intraoperatively in corrective surgery, and to identify modifiable factors that may influence blood loss.

Methods: The study was a retrospective review of patients who underwent posterior corrective surgery for AIS between 2015 and 2020 at a single centre. A total of 43 patients were identified, of which 36 met the inclusion criteria. Sociodemographic data, intraoperative blood loss parameters, transfusion requirements, and use of tranexamic acid (TXA), intraoperative cell salvage (ICS) and ultrasonic bone scalpel (UBS) were documented. Data were analysed to identify factors affecting intraoperative blood loss and blood transfusion.

Results: The 36 patients (30 female, 6 male) had a median age of 16 (interquartile range: 13–17) years. The mean duration of surgery was 355 (± 75.4) minutes, and the average number of segments fused was 10.3 (± 1.9). The mean estimated blood loss (EBL) was 722.2 (± 328.3) ml, with the mean percentage blood loss being 23 (± 11.6)%. A total of 11 patients (31%) received a blood transfusion; in these patients every 139.6 ml of blood lost resulted in one unit of blood being transfused (p = 0.005). Statistically significant differences in mean EBL were found with the use of TXA (p = 0.018) and UBS (p = 0.01). Use of ICS did not result in statistically significant differences in mean EBL. A direct correlation was also found with EBL and the duration of surgery (p = 0.025), and the number of segments fused (p = 0.005).

Conclusion: Multifactorial blood management strategies should be implemented to decrease blood loss and reduce the need for blood transfusion in corrective scoliosis surgery. These include the use of TXA, UBS and ICS. Additionally, attempts should be made to decrease the duration of surgery.

Level of evidence: 3