Aftab, Mohammad Hamza Sultan2025-03-262022-11Aftab, Mohammad Hamza Sultan. (2022). Blood management strategies in posterior corrective surgery for idiopathic scoliosis. [Masters dissertation, University of the Witwatersrand, Johannesburg]. WIReDSpace. https://hdl.handle.net/10539/44457https://hdl.handle.net/10539/44457A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine, to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2022.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.en©2022 University of the Witwatersrand, Johannesburg. All rights reserved. The copyright in this work vests in the University of the Witwatersrand, Johannesburg. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of University of the Witwatersrand, Johannesburg.Idiopathic scoliosisEstimated blood lossBlood management strategiesTreatment acidUltrasonic bone scalpelIntra-operative cell salvageUCTDDissertationUniversity of the Witwatersrand, JohannesburgSDG-3: Good health and well-beingSDG-4: Quality education