title: Aprotinin may decrease blood loss in complex adult spinal deformity surgery, but it may also increase the risk of acute renal failure.
abstract: METHODS
  Matched cohort comparison.
  
  
  OBJECTIVE
  This study examines the potential for aprotinin to conserve blood in adults undergoing long thoracolumbar deformity procedures and characterizes patients at risk for acute renal failure.
  
  
  BACKGROUND
  Aprotinin has been shown to reduce intraoperative blood loss and reduce transfusion requirement in pediatric spine and cardiac surgery populations. Previous literature (before 2006) has not reported acute renal failure as a potential complication. This study was designed to examine the efficacy of aprotinin in reducing operative blood loss following long spinal arthrodesis in adult spinal deformity patients and to analyze complications.
  
  
  METHODS
  Adult spinal deformity patients undergoing long spinal arthrodesis at 1 institution between 2001 and 2005 were analyzed. Patients were matched according to age and type of procedure performed. Forty patients received high-dose aprotinin (Group A) intraoperatively, and 41 patients matched as controls (Group NA) received no aprotinin. Outcome variables included intraoperative blood loss, intraoperative transfusion requirement, early postoperative blood loss and transfusion requirement, and postoperative complications.
  
  
  RESULTS
  Average blood loss for Group A was 906 mL and 1.3 L for Group NA. The difference was statistically significant with a P < 0.05. Complications seen in Group A included 4 cases of acute renal failure requiring dialysis and 1 deep venous thrombosis. In Group NA, there was only 1 case of acute renal failure (presumed to be secondary to inadvertent gentamycin overdose) and 1 case of pulmonary embolus. The 4 Group A patients with acute renal failure were female, 61 to 73 years of age, with various comorbidities. All required inpatient hemodialysis. Three averaged 2 months of continued outpatient dialysis before resolution of renal compromise while 1 patient is on chronic dialysis.
  
  
  CONCLUSIONS
  In long spinal arthrodesis for complex adult spinal deformity surgery, aprotinin does reduce intraoperative blood loss, but may increase the risk of acute renal failure, especially in women over the age of 60.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. gokubadejo@hotmail.com
authors.forename: Gbolahan O
authors.initials: GO
authors.lastname: Okubadejo
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Buchowski
authors.forename: David D
authors.initials: DD
authors.lastname: Fang
authors.forename: Christine R
authors.initials: CR
authors.lastname: Baldus
authors.forename: Carl H
authors.initials: CH
authors.lastname: Nielsen
authors.forename: Chris C
authors.initials: CC
authors.lastname: Lee
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000367:Age Factors; D000368:Aged; D007611:Aprotinin / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002318:Cardiovascular Diseases / Q000139:chemically induced; D016022:Case-Control Studies; D005260:Female; D006490:Hemostatics / Q000009:adverse effects*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013904:Thoracic Vertebrae / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D007611:Aprotinin