| Autor: |
Jeni Wincek, Diann Reischman, Matthew A. Halanski, John Huntington, Nabil Hassan, Dominic Sanfilippo, Jeffrey Cassidy, Deborah Tabert, Deanna Mitchell, Beth Kurt, Cecilia Wells, Surender Rajasekaran |
| Rok vydání: |
2011 |
| Předmět: |
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| Zdroj: |
Transfusion. 51:2133-2141 |
| ISSN: |
0041-1132 |
| DOI: |
10.1111/j.1537-2995.2011.03175.x |
| Popis: |
BACKGROUND: Pediatric scoliosis surgery is associated with considerable blood loss and allogenic transfusions. Transfusions contribute to morbidities and cost. A perioperative pediatric blood management program was implemented at our institution. Patients received preoperative evaluation, cell salvage, topical hemostasis, antifibrinolytics, and hypotensive anesthesia. STUDY DESIGN AND METHODS: The study was a 2-year retrospective cohort review of the program’s population from September 2007 through August 2009. RESULTS: A total of 110 scoliosis surgeries were performed with only 34 and 12% of the patients requiring preoperative oral iron and erythropoietin, respectively. Neuromuscular scoliosis patients had more repaired segments and a larger transfusion rate than idiopathic scoliosis patients (36% vs. 1.7%, p = 0.001). Transfused patients had more blood loss relative to their blood volume (p = 0.001) and blood loss was associated with higher Cobb angles (p = 0.04). Logistic regression revealed that blood loss (p = 0.001), number of segments fused (p = 0.004), and lower patient weight (p = 0.007) are associated with increased odds for transfusion. Twelve patients (10.9%) were identified with low von Willebrand activity with a trend toward higher blood losses (p = 0.07) with lower activity levels. CONCLUSION: Transfusion requirements in scoliosis patients are dependent on blood loss as determined by Cobb angles and number of segments fused relative to the patients’ blood volume as determined by weight. Implementation of a blood management protocol resulted in a low transfusion rate and unexpectedly led to the preoperative diagnosis of a number of patients with low levels of von Willebrand activity. P osterior scoliosis surgery is among the most complex and invasive surgeries performed in pediatric orthopedics. Due to the large surgical exposure of the highly vascular paraspinal muscles, vertebral bodies, and associated venous plexus, significant blood loss can be expected. From the current literature, patients undergoing scoliosis surgery can have up to 4.5 L of blood loss. 1,2 Blood loss is even more important when one considers that these patients are often immature adolescents with lower weight and smaller blood volume than adults. They often require from 1 to 8 units of allogeneic red blood cell (RBC) transfusion. 3-5 |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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