title: Does a kaolin-impregnated hemostatic dressing reduce intraoperative blood loss and blood transfusions in pediatric spinal deformity surgery?
abstract: METHODS
  Retrospective case-control study.
  
  
  OBJECTIVE
  To evaluate the hemostatic benefits of using a kaolin-impregnated dressing during pediatric spinal deformity correction surgery.
  
  
  BACKGROUND
  Minimizing blood loss and transfusions are clear benefits for patient safety. A technique common in both severe trauma and combat medicine that has not been reported in the spine literature is wound packing with a kaolin-impregnated hemostatic dressing.
  
  
  METHODS
  Estimated blood loss and transfusion amounts were analyzed in a total of 117 retrospectively identified cases. The control group included 65 patients (46 females, 19 males, 12.7±4.5 yr, 10.2±4.8 levels fused) who received standard operative care with gauze packing between June 2007 and March 2010. The treatment group included 52 patients (33 females, 19 males, 13.9±3.2 yr, 10.4±4.3 levels fused) who underwent intraoperative packing with QuikClot Trauma Pads (QCTP, Z-Medica Corporation) for all surgical procedures from July 2010 to August 2011. No other major changes in the use of antifibrinolytics or perioperative, surgical, or anesthesia technique were noted. Statistical differences were analyzed using analysis of covariance in R with P value of less than 0.05. The statistical model included sex, age, weight, scoliosis type, the number of vertebral levels fused, and surgery duration as covariates.
  
  
  RESULTS
  The treatment group had 40% less intraoperative estimated blood loss than the control group (974 mL vs. 1620 mL) (P<0.001). Patients who received the QCTP treatment also had 42% less total perioperative transfusion volume (499 mL vs. 862 mL) (P<0.01).
  
  
  CONCLUSIONS
  The use of a kaolin-impregnated intraoperative trauma pad seems to be an effective and inexpensive method to reduce intraoperative blood loss and transfusion volume in pediatric spinal deformity surgery.
  
  
  METHODS
  3.
authors.affiliation: *Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine †University of Missouri-Kansas City School of Medicine, Kansas City; and ‡Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Abbott
authors.forename: Sreeharsha V
authors.initials: SV
authors.lastname: Nandyala
authors.forename: Richard M
authors.initials: RM
authors.lastname: Schwend
mesh_terms: D000293:Adolescent; D001458:Bandages / Q000191:economics; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D002648:Child; D017046:Cost Savings; D005260:Female; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000008:administration & dosage* / Q000191:economics; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007430:Intraoperative Care / Q000191:economics / Q000379:methods; D007615:Kansas; D007616:Kaolin; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000191:economics / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000191:economics; D015503:Surgical Sponges / Q000191:economics; D062606:Tertiary Care Centers / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D006490:Hemostatics; D007616:Kaolin