Blood Loss Control in Patients with Idiopathic Scoliosis Undergoing Spinal Fusion: Prospective Evaluation of a Cohort

Morais, Sebastião Vieira de; Araújo, Anderson Matheus Medeiros de; Sousa, Camila Costa Lacerda de

doi:10.1055/s-0043-1775887

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Sumário

Original Article • Rev. bras. ortop. 58 (6) • 2023 • https://doi.org/10.1055/s-0043-1775887 copy

Blood Loss Control in Patients with Idiopathic Scoliosis Undergoing Spinal Fusion: Prospective Evaluation of a Cohort^* * Study developed at the Orthopedics and Traumatology Service, Hospital Universitário Presidente Dutra, Universidade Federal do Maranhão, São Luís, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

This study aimed to identify risk factors for increased perioperative bleeding in scoliosis surgery.

Methods

This is a prospective cohort study including 30 patients with idiopathic scoliosis undergoing posterior instrumentation using the pedicle screw system at a university hospital.

Results

Intraoperative blood losses totaled 798.6 ± 340 mL (24.8% of blood volume). Nine subjects presented massive blood loss. On average, hemoglobin dropped by 3.7g/dL, and each patient received 1.4 blood bags. Postoperative blood loss was 693.4±331.1 mL, and the total number of days using a drain was 2.7±0.7. Intraoperatively, the following variables showed significant correlations (p<0.05) with increased bleeding: age, time from diagnosis to treatment, preoperative Cobb angle, amount of curve correction, number of instrumented and fixated levels, total number of screws, and the number of transfused bags. Postoperatively, the following variables had significant correlations (p < 0.05): age, preoperative Cobb angle, length of hospital stay, number of blood bags transfused, and number of levels fixated with screws.

Conclusion

The variables most contributing to blood loss were age, preoperative Cobb angle, number of blood bags transfused, and number of levels fixated with a screw. Therefore, patients may benefit from surgical treatment while younger and

Keywords
scoliosis; spinal fusion; hemorrhage; blood loss, surgical

Variable	Mean value	Standard deviation
Body mass index (kg/m²)	18.7	2.7
Age (years)	15.2	3.2
Time from diagnosis to treatment (years)	6.5	5.3
Preoperative Cobb angle (degrees)	64.7	18.2
Postoperative Cobb angle (degrees)	30.6	15.0
Curve correction amount in the coronal plane (degrees)	34.1	12.0
Preoperative sagittal modifier (T5–T12) (degrees)	29.4	26.6
Postoperative sagittal modifier (T5–T12) (degrees)	24.2	12.2
Sagittal modifier variation (degrees)	-5.2	19.4
Preoperative hemoglobin level (g/dL)	13.1	1.2
Intraoperative blood loss (mL)	798.6	340.0
Intraoperatively transfused blood bags (unit)	0.4	0.8
Number of instrumented levels	10.3	2.8
Number of levels fixated with pedicle screw	8.7	2.2
Total number of screws used	13.8	3.6
Surgical time (minutes)	202.4	63.0
Admission time (days)	6.3	3.7
Postoperatively transfused blood bags (unit)	1.0	1.2
Postoperative hemoglobin level (g/dL)	9.4	1.4
Postoperative total drain loss (mL)	693.4	331.1
Total number of days using drain	2.7	0.7

Variable	Intraoperative blood loss
Variable	Correlation	p
Intraoperatively transfused blood bags (unit)	0.742	0.000
Preoperative Cobb angle(degrees)	0.687	0.000
Age (years)	0.571	0.003
Time from diagnosis to treatment (years)	0.561	0.004
Total number of screws used	0.500	0.011
Number of levels fixated with pedicle screw	0.490	0.012
Curve correction amount in the coronal plane (degrees)	0.479	0.015
Number of instrumented levels	0.462	0.019
Postoperatively transfused blood bags (unit)	0.459	0.020
Surgical time (minutes)	0.372	0.067
Admission time (days)	0.313	0.126
Sagittal modifier variation (degrees)	-0.276	0.180
Preoperative sagittal modifier (T5–T12) (degrees)	-0.253	0.221
Body mass index (kg/m²)	0.110	0.598
Weight (kilograms)	0.094	0.652
Postoperative hemoglobin level (g/dL)	-0.029	0.888
Preoperative hemoglobin level (g/dL)	-0.027	0.898
Age at diagnosis (years)	-0.009	0.964

Variable	Post-operative blood loss
Variable	Correlation	p
Intraoperatively transfused blood bags (unit)	0.583	0.002
Admission time (days)	0.552	0.004
Preoperative Cobb angle(degrees)	0.470	0.017
Postoperatively transfused blood bags (unit)	0.458	0.021
Age (years)	0.440	0.027
Number of levels fixated with pedicle screw	0.441	0.027
Surgical time (minutes)	0.391	0.053
Total number of screws used	0.387	0.055
Curve correction amount in the coronal plane (degrees)	0.354	0.082
Number of instrumented levels	0.326	0.111
Time from diagnosis to treatment (years)	0.293	0.154
Postoperative Cobb angle (degrees)	0.288	0.162
Postoperative hemoglobin level (g/dL)	-0.285	0.167
Preoperative sagittal modifier (T5–T12) (degrees)	0.184	0.376
Sagittal modifier variation (degrees)	-0.158	0.447
Weight (kilograms)	0.126	0.547
Body mass index (kg/m²)	-0.048	0.819
Age at diagnosis (years)	-0.029	0.888
Preoperative hemoglobin level (g/dL)	0.015	0.941

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Anderson Matheus Medeiros de Araújo, Serviço de Ortopedia e Traumatologia do Hospital Universitário Presidente Dutra, Universidade Federal do Maranhão, São Luís, Maranhão, Brasil (e-mail: andersonmatheus@hotmail.com).

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Blood Loss Control in Patients with Idiopathic Scoliosis Undergoing Spinal Fusion: Prospective Evaluation of a Cohort* * Study developed at the Orthopedics and Traumatology Service, Hospital Universitário Presidente Dutra, Universidade Federal do Maranhão, São Luís, Brazil.

Abstract

Objective

Methods

Results

Conclusion

Blood Loss Control in Patients with Idiopathic Scoliosis Undergoing Spinal Fusion: Prospective Evaluation of a Cohort^* * Study developed at the Orthopedics and Traumatology Service, Hospital Universitário Presidente Dutra, Universidade Federal do Maranhão, São Luís, Brazil.