Effects of race on blood loss in spinal fusions for adolescent idiopathic scoliosis

2020 ◽  
pp. 1-5
Author(s):  
Neil Kaushal ◽  
Keith J. Orland ◽  
Andrew M. Schwartz ◽  
Jacob M. Wilson ◽  
Nicholas D. Fletcher ◽  
...  
Keyword(s):  
African American ◽  
Adolescent Idiopathic Scoliosis ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Posterior Spinal Fusion ◽  
Transfusion Rate ◽  
Racial Groups ◽  
Significant Difference ◽  
History Of ◽  
Caucasian Patients

OBJECTIVEPosterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can be associated with significant blood loss. It has been suggested that blood loss is greater in different racial groups. The purpose of this study was to evaluate differences in blood loss between African American and Caucasian patients undergoing PSF for AIS.METHODSA retrospective review was performed of patients aged 10–18 years with AIS who were treated with PSF from 2014 to 2017 at a single children’s healthcare system. Patient demographic, radiographic, and operative data were obtained from medical records. Intraoperative blood loss was calculated using the formula described by Waters et al. Patients who declined reporting their race or had prior spinal surgery, neuromuscular or syndromic diagnoses, a history of cardiac or thoracic surgery, or a bleeding disorder were excluded. Blood loss variables were log-transformed for normality and modeled using multivariable linear regression.RESULTSA total of 433 PSFs for AIS qualified for the analysis. The average age was 14.1 years, and 73.7% of the patients were female. With respect to race, 44.6% identified themselves as African American. There was no significant difference in blood loss (p = 0.31) or blood loss per level fused (p = 0.36) in African American patients. African American patients, however, did have significantly lower preoperative hemoglobin and hematocrit levels and greater operating room time than Caucasian patients (p < 0.001). There was no difference between race and transfusion rate.CONCLUSIONSThere appears to be no relationship between race and blood loss during PSF for AIS. Standardized protocols for minimizing perioperative blood loss can be applied to both Caucasian and African American patients.

scholarly journals Predictive factors for intraoperative blood loss in surgery for adolescent idiopathic scoliosis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chris Yuk Kwan Tang ◽  
Vijay H. D. Kamath ◽  
Prudence Wing Hang Cheung ◽  
Jason Pui Yin Cheung
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Predictive Factors ◽  
Posterior Spinal Fusion ◽  
Male Gender ◽  
Intraoperative Blood Loss ◽  
Operative Blood Loss ◽  
Operation Duration

Abstract Background Adolescent idiopathic scoliosis (AIS) is a common spinal deformity. Posterior spinal fusion remains an important surgical treatment for AIS. This study aims to determine the predictive factors for intraoperative blood loss in AIS surgery. Methods Patients who had undergone posterior spinal fusion for adolescent idiopathic scoliosis in a single university hospital were reviewed over a 7-year period. Predictive factors for intra-operative blood loss were studied by multivariate analysis to derive a regression model. Receiver operating characteristic analysis was performed to determine the cut-off values of factors contributing to significant intraoperative blood loss (≥500 ml). Results Two hundred and twelve patients were included. Intraoperative blood loss was found to be correlated with gender (rs = 0.30 (0.17–0.43)), preoperative hemoglobin level (rs = 0.20 (0.04–0.31)), preoperative Cobb angle (rs = 0.20 (0.02–0.29)), number of fused levels (rs = 0.46 (0.34–0.58)), operation duration (rs = 0.65 (0.54–0.75)), number of anchors (rs = 0.47 (0.35–0.59)), and p-value ranged from < 0.001 to < 0.05. Significant intraoperative blood loss was influenced by the male gender, operation duration greater than 257.5 min and more than 10 anchors used. Conclusions Male gender, increased operation duration and higher number of anchors predicted higher intra-operative blood loss.

scholarly journals Hidden Blood Loss in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion Surgery: A Retrospective Study of 765 Cases in a Single Center

2021 ◽  
Author(s):  
Lipeng Wang ◽  
Jiangli Liu ◽  
Xiaoxiao Song ◽  
Muhui Luo ◽  
Yongquan Chen
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Adolescent Idiopathic Scoliosis ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Posterior Spinal Fusion ◽  
Postoperative Blood Transfusion ◽  
Independent Risk Factors

Abstract Purpose: To investigate Hidden blood loss (HBL) and its potential risk factors in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgery and elucidate the influence of HBL on postoperative blood transfusion. Methods: We retrospectively studied 765 patients undergoing posterior spine fusion for adolescent idiopathic scoliosis from January 2014 to December 2018. The patient’s demographics, blood loss related parameters, operation and blood loss information were extracted. The association between patient’s characteristics and HBL was analyzed by Pearson or Spearman correlation analysis. Multivariate linear regression analysis was used to determine independent risk factors associated with HBL. Binary logistic regression analysis was used to analyze the influence of HBL on postoperative blood transfusion.Results: A total of 765 patients including 128 males and 637 females (age range 10-18 years) were included in this study. The mean amount of HBL was 693.5±473.4 ml, accounting for 53.9% of the total blood loss. In multivariate linear regression analysis, we found that preoperative Hct (p=0.003) and allogeneic blood transfusion (p<0.0001) were independent risk factors for HBL, while tranexamic acid (p=0.003) was negatively related to HBL. Binary logistic regression analysis showed that HBL > 850 ml ( P < 0.001, OR: 8.845, 95%CI: 5.806-13.290) was the independent risk factor for postoperative blood transfusion.Conclusion: a large amount of HBL was incurred in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgeries. Allogeneic blood transfusion and preoperative Hct were independent risk factors for HBL, while tranexamic acid was negatively related to HBL. HBL and its influential factors should be taken into account when considering the perioperative transfusion management. These patients with HBL greater than 850 ml should be paid more attention in case of postoperative anemia.Level of evidence: Level III

An analysis of preoperative shoulder and neck balance and surgical outcome in 111 adolescent idiopathic scoliosis patients with two subtypes of Lenke 1 curves

2021 ◽  
Vol 34 (1) ◽  
pp. 37-44
Author(s):  
Chris Yin Wei Chan ◽  
Chee Kidd Chiu ◽  
Yun Hui Ng ◽  
Saw Huan Goh ◽  
Xin Yi Ler ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Surgical Outcome ◽  
Posterior Spinal Fusion ◽  
Current Treatment ◽  
Shoulder Balance ◽  
Significant Difference ◽  
Postoperative Shoulder Imbalance ◽  
Postoperative Shoulder

OBJECTIVEThe incidence of postoperative shoulder imbalance following posterior spinal fusion (PSF) is still high in Lenke 1 curves despite following current treatment recommendations for upper instrumented vertebra (UIV) selection. The objective of this retrospective study was to identify differences in preoperative shoulder balance and to report the surgical outcome of two subtypes of Lenke 1 curves (flexible vs stiff) in patients with adolescent idiopathic scoliosis (AIS).METHODSThe authors grouped patients’ curves as Lenke 1–ve (flexible) when their preoperative proximal thoracic side bending (PTSB) Cobb angle was < 15° and as Lenke 1+ve (stiff) when the PTSB Cobb angle was 15°–24.9°. The authors hypothesized that these two subtypes had distinct preoperative and postoperative shoulder and neck balance following PSF using pedicle screw constructs.RESULTSFifty patients had Lenke 1 (flexible) curves and 61 had Lenke 1 (stiff) curves. The mean preoperative T1 tilt for patients with Lenke 1 (flexible) was −4.9° ± 5.3°, and for those with Lenke 1 (stiff) curves it was −1.0° ± 5.3° (p < 0.001). Mean cervical axis (CA) was −0.1° ± 3.2° for Lenke 1 (flexible) curves and 2.3° ± 3.5° for Lenke 1 (stiff) curves (p < 0.001). Preoperative radiographic shoulder height (RSH) and clavicle angle (Cla-A) were similar between the two curve subtypes. Following surgery, there were significant differences between the subtypes in terms of T1 tilt (p < 0.001), RSH (p = 0.014), and Cla-A (p = 0.031). Interestingly, 41.0% of patients with a Lenke 1 (stiff) curve had +ve T1 tilt compared to 2.0% in Lenke 1 (flexible) group. Moreover, 26.2% of patients with the Lenke 1 (stiff) curve had +ve RSH compared to 12.0% of those with Lenke 1 (flexible) curves. And, 24.6% of patients with Lenke 1 (stiff) had +ve Cla-A compared to 10.0% of those with Lenke 1 (flexible) curves.CONCLUSIONSLenke 1 (flexible) and Lenke 1 (stiff) curves had distinct preoperative T1 tilt and CA measurements. Following PSF, the authors noted +ve T1 tilt in 41% of patients with Lenke 1 (stiff) curves versus 2.0% in those with Lenke 1 (flexible) curves. The authors also noted a significant difference in postoperative RSH and Cla-A measurements.

Does the Intraoperative Tranexamic Acid Decrease Operative Blood Loss During Posterior Spinal Fusion for Treatment of Adolescent Idiopathic Scoliosis?

Spine ◽  
2012 ◽  
Vol 37 (21) ◽  
pp. E1336-E1342 ◽  
Author(s):  
Mitsuru Yagi ◽  
Jun Hasegawa ◽  
Narihito Nagoshi ◽  
Shingo Iizuka ◽  
Shinjiro Kaneko ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Tranexamic Acid ◽  
Spinal Fusion ◽  
Posterior Spinal Fusion ◽  
Operative Blood Loss

scholarly journals Hidden blood loss in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgery: a retrospective study of 765 cases at a single centre

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lipeng Wang ◽  
Jiangli Liu ◽  
Xiaoxiao Song ◽  
Muhui Luo ◽  
Yongquan Chen
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Adolescent Idiopathic Scoliosis ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Posterior Spinal Fusion ◽  
Hidden Blood Loss ◽  
Postoperative Blood Transfusion ◽  
Independent Risk Factors

Abstract Background In scoliosis corrective surgery, total blood loss is composed of visible blood loss, including intraoperative haemorrhage and drainage, and hidden blood loss in which blood extravasates into the tissues and accumulates in the surgical field. The purpose of this study was to investigate hidden blood loss (HBL) and its potential risk factors in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgery and elucidate the influence of HBL on the necessity for postoperative blood transfusion. Methods We retrospectively studied adolescent idiopathic scoliosis patients undergoing posterior spine fusion for adolescent idiopathic scoliosis from January 2014 to December 2018 at our hospital. The patients’ demographics, blood loss-related parameters, surgeries and blood loss data were extracted. The association between patient characteristics and HBL was analyzed by Pearson or Spearman correlation analyses. Multivariate linear regression analysis was used to determine independent risk factors associated with HBL. Binary logistic regression analysis was used to analyze the influence of HBL on the necessity for postoperative blood transfusion. Results A total of 765 patients, of whom 128 were male and 637 were female (age range 10–18 years), were included in this study. The mean volume of HBL was 693.5 ± 473.4 ml, accounting for 53.9 % of the total blood loss. The multivariate linear regression analysis revealed that preoperative Hct (p = 0.003) and allogeneic blood transfusion (p < 0.001) were independent risk factors for HBL, while tranexamic acid (p = 0.003) was negatively correlated with HBL. Binary logistic regression analysis showed that HBL > 850 ml (P < 0.001, OR: 8.845, 95 % CI: 5.806–13.290) was an independent risk factor for the necessity for postoperative blood transfusion. Conclusions Substantial HBL occurred in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgeries. Allogeneic blood transfusion and preoperative Hct were independent risk factors for HBL, while tranexamic acid was negatively related to HBL. HBL and its influencing factors should be considered when planning perioperative transfusion management. Patients with HBL greater than 850 ml should be closely monitored in cases of postoperative anaemia. Level of evidence Level III.

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