Mild hypothermia, blood loss and complications in elective spinal surgery

Background: Spinal surgeries are often accompanied by significant blood loss both intraoperatively and postoperatively. Excessive blood loss caused by surgery may lead to several harmful medical consequences. Tranexamic acid (TXA) is a kind of antifibrinolytic agent that has been widely used in spinal surgery. Currently, it is commonly accepted that intravenous TXA (ivTXA) can reduce blood loss in spinal fusion surgeries. Compared with ivTXA, topical TXA (tTXA) seems to be much easier to administer. This advantage provides a maximum concentration of TXA at the hemorrhagic site with little to no TXA entering the circulation. Objective: To evaluate the effect of tTXA on blood loss during and after spinal surgery via a comprehensive meta-analysis of the published data in randomized controlled trials (RCTs) and other comparative cohort studies. Methods: A comprehensive search of PubMed, EMBASE, the Web of Science, and the Cochrane Central Register of Controlled Trials were performed for RCTs and other comparative cohort studies on the effect of tTXA on blood loss during and after spinal surgery. The outcomes were total blood loss, hidden blood loss, intraoperative blood loss, total postoperative drainage volume, drainage tube duration postoperatively, drainage volume and drainage of blood content at postoperative day (POD) 1 and POD2, length of hospital stay, number of patients who received a blood transfusion, serum HB level at POD1, operative timespan, side effects, and complications. The final search was performed in October 2020. We followed the PRISMA guideline, and the registration number is INPLASY202160028. Results: In total, six studies with 481 patients were included. tTXA treatment, compared with the control conditions, can significantly reduce the total blood loss, hidden blood loss, total postoperative drainage volume, and several patients receiving blood transfusions; reduce the drainage volume and drainage of blood content at POD1; shorten the drainage tube duration postoperatively and length of hospital stay, and enhance the serum HB level at POD1 for spinal surgery. tTXA treatment did not significantly influence the intraoperative blood loss, drainage volume, or drainage of blood content at POD2 or the operative duration. Conclusion: Compared with control conditions, tTXA has high efficacy in reducing blood loss, and drainage volume enable quick rehabilitation and has a relatively high level of safety in spinal surgery.

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Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty

Transfusion Medicine Reviews ◽

10.1016/s0887-7963(97)80034-x ◽

1997 ◽

Vol 11 (1) ◽

pp. 82

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Hip Arthroplasty ◽

Mild Hypothermia ◽

Total Hip ◽

Transfusion Requirements

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Comparison of the Blood Loss during and after Spinal Surgery under Hypotensive Anesthesia and Effects of Furosemide on the Urine Output during Hypotensive Anesthesia for Spinal Surgery

Korean Journal of Anesthesiology ◽

10.4097/kjae.1998.35.6.1105 ◽

1998 ◽

Vol 35 (6) ◽

pp. 1105

Author(s):

Chang Kil Park

Keyword(s):

Blood Loss ◽

Spinal Surgery ◽

Urine Output ◽

Hypotensive Anesthesia

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Reduction of blood loss using aprotonin during spinal surgery in children for non-idiopathic scoliosis.

Pediatric Anesthesia ◽

10.1046/j.1460-9592.2002.10271_28.x ◽

2002 ◽

Vol 12 (9) ◽

pp. 835-835 ◽

Cited By ~ 3

Author(s):

V. Colovic ◽

R.W.M. Walker ◽

D. Patel ◽

S. Rushman

Keyword(s):

Blood Loss ◽

Idiopathic Scoliosis ◽

Spinal Surgery

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Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial

Journal of Neurosurgery Spine ◽

10.3171/2018.10.spine18487 ◽

2019 ◽

Vol 30 (5) ◽

pp. 615-622 ◽

Cited By ~ 24

Author(s):

Xiaoguang Han ◽

Wei Tian ◽

Yajun Liu ◽

Bo Liu ◽

Da He ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radiation Exposure ◽

Pedicle Screw ◽

Spinal Surgery ◽

Facet Joint ◽

Postoperative Hospital Stay ◽

Screw Placement ◽

Pedicle Screw Placement ◽

The Mean

OBJECTIVEThe object of this study was to compare the safety and accuracy of pedicle screw placement using the TiRobot system versus conventional fluoroscopy in thoracolumbar spinal surgery.METHODSPatients with degenerative or traumatic thoracolumbar spinal disorders requiring spinal instrumentation were randomly assigned to either the TiRobot-assisted group (RG) or the freehand fluoroscopy-assisted group (FG) at a 1:1 ratio. The primary outcome measure was the accuracy of screw placement according to the Gertzbein-Robbins scale; grades A and B (pedicle breach < 2 mm) were considered clinically acceptable. In the RG, discrepancies between the planned and actual screw placements were measured by merging postoperative CT images with the trajectory planning images. Secondary outcome parameters included proximal facet joint violation, duration of surgery, intraoperative blood loss, conversion to freehand approach in the RG, postoperative hospital stay, and radiation exposure.RESULTSA total of 1116 pedicle screws were implanted in 234 patients (119 in the FG, and 115 in the RG). In the RG, 95.3% of the screws were perfectly positioned (grade A); the remaining screws were graded B (3.4%), C (0.9%), and D (0.4%). In the FG, 86.1% screws were perfectly positioned (grade A); the remaining screws were graded B (7.4%), C (4.6%), D (1.4%), and E (0.5%). The proportion of clinically acceptable screws was significantly greater in the RG than in the FG (p < 0.01). In the RG, the mean deviation was 1.5 ± 0.8 mm for each screw. The most common direction of screw deviation was lateral in the RG and medial in the FG. Two misplaced screws in the FG required revision surgery, whereas no revision was required in the RG. None of the screws in the RG violated the proximal facet joint, whereas 12 screws (2.1%) in the FG violated the proximal facet joint (p < 0.01). The RG had significantly less blood loss (186.0 ± 255.3 ml) than the FG (217.0 ± 174.3 ml; p < 0.05). There were no significant differences between the two groups in terms of surgical time and postoperative hospital stay. The mean cumulative radiation time was 81.5 ± 38.6 seconds in the RG and 71.5 ± 44.2 seconds in the FG (p = 0.07). Surgeon radiation exposure was significantly less in the RG (21.7 ± 11.5 μSv) than in the FG (70.5 ± 42.0 μSv; p < 0.01).CONCLUSIONSTiRobot-guided pedicle screw placement is safe and useful in thoracolumbar spinal surgery.Clinical trial registration no.: NCT02890043 (clinicaltrials.gov)

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