Blood management in pediatric spinal deformity surgery: Review of a 2-year experience

Nabil Hassan, Matthew Halanski, Jeni Wincek, Diann Reischman, Dominic Sanfilippo, Surender Rajasekaran, Cecilia Wells, Deborah Tabert, Beth Kurt, Deanna Mitchell, John Huntington, Jeffrey Cassidy

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2133-2141
Number of pages9
JournalTransfusion
Volume51
Issue number10
DOIs
StatePublished - Oct 1 2011

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Pediatrics
Scoliosis
Blood Volume
Weights and Measures
Antifibrinolytic Agents
Population Control
Erythropoietin
Hemostasis
Anesthesia
Iron
Logistic Models
Morbidity
Costs and Cost Analysis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Hassan, N., Halanski, M., Wincek, J., Reischman, D., Sanfilippo, D., Rajasekaran, S., ... Cassidy, J. (2011). Blood management in pediatric spinal deformity surgery: Review of a 2-year experience. Transfusion, 51(10), 2133-2141. https://doi.org/10.1111/j.1537-2995.2011.03175.x

Blood management in pediatric spinal deformity surgery : Review of a 2-year experience. / Hassan, Nabil; Halanski, Matthew; Wincek, Jeni; Reischman, Diann; Sanfilippo, Dominic; Rajasekaran, Surender; Wells, Cecilia; Tabert, Deborah; Kurt, Beth; Mitchell, Deanna; Huntington, John; Cassidy, Jeffrey.

In: Transfusion, Vol. 51, No. 10, 01.10.2011, p. 2133-2141.

Research output: Contribution to journalArticle

Hassan, N, Halanski, M, Wincek, J, Reischman, D, Sanfilippo, D, Rajasekaran, S, Wells, C, Tabert, D, Kurt, B, Mitchell, D, Huntington, J & Cassidy, J 2011, 'Blood management in pediatric spinal deformity surgery: Review of a 2-year experience', Transfusion, vol. 51, no. 10, pp. 2133-2141. https://doi.org/10.1111/j.1537-2995.2011.03175.x
Hassan, Nabil ; Halanski, Matthew ; Wincek, Jeni ; Reischman, Diann ; Sanfilippo, Dominic ; Rajasekaran, Surender ; Wells, Cecilia ; Tabert, Deborah ; Kurt, Beth ; Mitchell, Deanna ; Huntington, John ; Cassidy, Jeffrey. / Blood management in pediatric spinal deformity surgery : Review of a 2-year experience. In: Transfusion. 2011 ; Vol. 51, No. 10. pp. 2133-2141.
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abstract = "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.",
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T2 - Review of a 2-year experience

AU - Hassan, Nabil

AU - Halanski, Matthew

AU - Wincek, Jeni

AU - Reischman, Diann

AU - Sanfilippo, Dominic

AU - Rajasekaran, Surender

AU - Wells, Cecilia

AU - Tabert, Deborah

AU - Kurt, Beth

AU - Mitchell, Deanna

AU - Huntington, John

AU - Cassidy, Jeffrey

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N2 - 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.

AB - 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.

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