title: Blood management in pediatric spinal deformity surgery: review of a 2-year experience.
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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Grand Valley State University, Allendale, Michigan, USA. nabil.hassan@helendevoschildrens.org
authors.forename: Nabil
authors.initials: N
authors.lastname: Hassan
authors.forename: Matthew
authors.initials: M
authors.lastname: Halanski
authors.forename: Jeni
authors.initials: J
authors.lastname: Wincek
authors.forename: Diann
authors.initials: D
authors.lastname: Reischman
authors.forename: Dominic
authors.initials: D
authors.lastname: Sanfilippo
authors.forename: Surender
authors.initials: S
authors.lastname: Rajasekaran
authors.forename: Cecilia
authors.initials: C
authors.lastname: Wells
authors.forename: Deborah
authors.initials: D
authors.lastname: Tabert
authors.forename: Beth
authors.initials: B
authors.lastname: Kurt
authors.forename: Deanna
authors.initials: D
authors.lastname: Mitchell
authors.forename: John
authors.initials: J
authors.lastname: Huntington
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cassidy
mesh_terms: D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000150:complications; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001810:Blood Volume; D001835:Body Weight; D015331:Cohort Studies; D019587:Dietary Supplements; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion; D019851:Thrombophilia / Q000150:complications
chemical_list: D004921:Erythropoietin; D005492:Folic Acid; D007501:Iron