title: Canadian Consensus for the Prevention of Blood Loss in Spine Surgery.
abstract: METHODS
  Cross-sectional, modified Delphi approach.
  
  
  OBJECTIVE
  The primary objective of this study was to identify patients at risk of increased perioperative blood loss according to the opinion of expert spine surgeons across Canada. The secondary objective was to obtain information about the experts' approach on how to minimize significant blood loss perioperatively.
  
  
  BACKGROUND
  Significant blood loss in major spinal surgeries has been associated with increased intra- and perioperative complications and costs. The current available evidence regarding risk factors and preventive measures for increased blood loss remains incomplete.
  
  
  METHODS
  A modified Delphi approach was employed to generate consensus opinion on the risk factors and preventive measures for significant blood loss in major spinal surgeries. Twenty-five spine surgeons in Canada participated in this study.
  
  
  RESULTS
  Among various factors, surgery for the treatment of spine tumors and prolonged operative time of greater than 5 hours were found to be the most important predictive factors for blood loss in spine surgery. On the other hand, appropriate surgical hemostasis was considered the most effective measure for the prevention of blood loss in these surgeries.
  
  
  CONCLUSIONS
  We recommend the reduction of blood loss by means of meticulous hemostasis and shorter operative time when it is safe and possible. This might result in better treatment outcomes. It would also lead to a reduction in costs associated with major spine surgeries and would ultimately lead to greater value-based spine care.
  
  
  METHODS
  4.
authors.affiliation: Division of Orthopedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Thierry
authors.initials: T
authors.lastname: Pauyo
authors.affiliation: Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Verma
authors.affiliation: Division of Orthopedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.|Department of Orthopedic Surgery, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Marwan
authors.affiliation: Division of Orthopedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aoude
authors.affiliation: Division of Orthopedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Morsi
authors.initials: M
authors.lastname: Khashan
authors.affiliation: Division of Orthopedic Surgery, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Weber
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002170:Canada; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D061646:Operative Time; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012307:Risk Factors; D013131:Spine / Q000601:surgery*