title: Efficacy of preoperative erythropoietin administration in pediatric neuromuscular scoliosis patients.
abstract: METHODS
  This is a retrospective cohort study examining 61 patients with neurogenic scoliosis who underwent anterior and/or posterior spinal instrumentation at the age of 18 and younger.
  
  
  OBJECTIVE
  The purpose of this study is to investigate this finding further by analyzing the effect of recombinant human erythropoietin (rhEPO) on hematocrit, transfusion and complication rates, and the length of intensive care unit (ICU) days in patients with neurogenic scoliosis.
  
  
  BACKGROUND
  The preoperative use of rhEPO has been shown to decrease perioperative transfusion requirements in many adult and pediatric patients. A recent study at our institution demonstrated the efficacy of rhEPO in pediatric idiopathic scoliosis patients, but suggested the possibility of an "erythropoietin resistance" in the pediatric neurogenic scoliosis population.
  
  
  METHODS
  The patients' age at the time of surgery, gender, Cobb angle, erythropoietin administration and dosage, hematocrit levels, type of surgery, intraoperative blood loss, duration of surgery, number of vertebrae fused, comorbidities, complications, transfusion status, and the length of ICU days were collected.
  
  
  RESULTS
  Thirty-five (57.3%) children received preoperative rhEPO, whereas 26 patients (42.7%) did not receive rhEPO. The mean preoperative and discharge hematocrit levels in the patients treated with rhEPO were significantly higher than the non-rhEPO group (P = 0.05). There were no significant difference in likelihood of transfusion, complications, and the length of ICU days between the rhEPO and the non-rhEPO groups. A multivariate analysis demonstrated that the number of fused vertebral levels maintained its significance (P = 0.044) and surgical time had a trend toward significance (P = 0.051) in predicting likelihood of transfusion.
  
  
  CONCLUSIONS
  The use of rhEPO effectively stimulated erythropoiesis in these patients and yet demonstrated no significant clinical benefit in reducing the likelihood of transfusion in neurogenic patients in this study. More research is necessary to design a transfusion risk reduction protocols that will minimize the exposure of neurogenic scoliosis patients to allogeneic blood products.
authors.affiliation: Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA. mgv1@columbia.edu
authors.forename: Michael G
authors.initials: MG
authors.lastname: Vitale
authors.forename: David M
authors.initials: DM
authors.lastname: Privitera
authors.forename: Hiroko
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Gomez
authors.forename: Linda M
authors.initials: LM
authors.lastname: Waters
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Hyman
authors.forename: David P
authors.initials: DP
authors.lastname: Roye
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000517:prevention & control*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006400:Hematocrit; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009468:Neuromuscular Diseases / Q000150:complications; D011183:Postoperative Complications / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin