title: Perioperative blood conservation strategies for major spine surgery.
abstract: BACKGROUND
  Orthopedic surgery, especially spine and spinal deformity surgery, may be associated with high perioperative blood loss. In order to reduce the risk of excessive blood loss and unnecessary blood transfusions, strategies such as Patient Blood Management including goal-directed coagulation management have been developed.
  
  
  RESULTS
  Adverse effects of allogeneic blood transfusions have been shown for most surgical fields including orthopedic surgery. Several efforts have been made to increase the preoperative red blood cell (RBC) mass, to reduce the intraoperative blood loss, and to use restrictive transfusion triggers in order to minimize or avoid RBC transfusions. Measures to reduce intraoperative blood loss include new surgical techniques, use of cell salvage where possible, bedside coagulation management with point-of-care devices, substitution of coagulation factors, antifibrinolytic agents, and desmopressin, induced hypotension, and avoidance of hypothermia.
  
  
  CONCLUSIONS
  Blood conservation in spinal surgery is a multidisciplinary approach and the efficacy of most single measures has been shown. Cost-effectiveness and the benefits of long-term patient outcomes are the subjects of current and future research.
authors.affiliation: Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland. Electronic address: oliver@theusinger.de.
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Theusinger
authors.affiliation: Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods*; D019990:Perioperative Care / Q000379:methods; D019095:Point-of-Care Systems; D013122:Spinal Diseases / Q000601:surgery; D013131:Spine / Q000601:surgery*; D065227:Transfusion Reaction
chemical_list: D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors
keywords: Patient Blood Management; ROTEM(®); goal-directed transfusions; spinal deformity surgery; spine surgery; thrombelastometry; transfusion management