Blood management strategies in posterior corrective surgery for idiopathic scoliosis

Abstract

Background: Corrective surgery for idiopathic scoliosis is associated with large volumes of blood loss and a need for blood transfusion. The aim of the study was to measure blood loss and blood products used intra-operatively 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 idiopathic scoliosis between 2015 and 2020. A total of 43 patients were identified, of which 36 met the inclusion criteria. Sociodemographic data, intra-operative blood loss parameters, transfusion requirements, and use of tranexamic acid, intra-operative cell salvage and ultrasonic bone scalpel were documented. Data were analysed to identify factors affecting intra-operative 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 (+/-75.38) minutes and the average number of segments fused was 10.25 (+/- 1.87). The mean estimated blood loss was 722.22 (+/-328.30) mL with the mean percentage blood loss being 22.99 (+/-11.61) %. A total of 11 patients (30.56%) received a blood transfusion; in these patients every 139.58 mL of blood lost resulted in 1 unit of blood being transfused (p=0.005). Statistically significant differences in mean estimated blood loss were found with the use of tranexamic acid (p=0.018) and ultrasonic bone scalpel (p=0.01). The use of intra-operative cell salvage did not result in statistically significant differences in mean estimated blood loss. A direct correlation was also found with estimated blood loss and the duration of surgery (p=0.025), and the number of segments fused (p=0.005). Conclusion: Modifiable factors affecting intra-operative blood loss include the use of tranexamic acid, ultrasonic bone scalpel, duration of surgery and the number of segments fused. A multifactorial blood management strategy should be implemented to decrease blood loss and reduce the need for blood transfusion in corrective scoliosis surgery.