Purpose

The objective is to analyse peri-operative blood loss (BL) and hidden blood loss (HBL) rates in spinal deformity complex cases surgery, with a focus on the strategies to prevent major bleeding.

Methods

We retrospectively analysed surgical and anaesthesiologic data of patients who had been operated for adolescent idiopathic scoliosis (AIS) or adult spinal deformities (ASD) with a minimum of five levels fused. A statistical comparison among AIS, ASD without a pedicle subtraction osteotomy (PSO) (ASD-PSO( −)) and ASD with PSO (ASD-PSO( +)) procedures was performed with a view to identifying patient- and/or surgical-related factors affecting peri-operative BL and HBL.

Results

One-hundred patients were included with a mean 9.9 ± 2.8 fused vertebrae and a mean 264.2 ± 68.3 minutes operative time (OT) (28.3 ± 9 min per level). The mean perioperative BL was 641.2 ± 313.8 ml (68.9 ± 39.5 ml per level) and the mean HBL was 556.6 ± 381.8 ml (60.6 ± 42.8 ml per level), with the latter accounting for 51.5% of the estimated blood loss (EBL). On multivariate regression analysis, a longer OT (p < 0.05; OR 3.38) and performing a PSO (p < 0.05; OR 3.37) were related to higher peri-operative BL, while older age (p < 0.05; OR 2.48) and higher BMI (p < 0.05; OR 2.15) were associated to a more significant post-operative HBL.

Conclusion

With the correct use of modern technologies and patient management, BL in major spinal deformity surgery can be dramatically reduced. Nevertheless, it should be kept in mind that 50% of patients estimated losses are hidden and not directly controllable. Knowing the per-level BL allows anticipating global losses and, possibly, the need of allogenic transfusions.

中文翻译：

---

复杂后路脊柱手术中的团队管理允许失血限制

目的

目的是分析脊柱畸形复杂病例手术的围手术期失血 (BL) 和隐性失血 (HBL) 率，重点是预防大出血的策略。

方法

我们回顾性分析了因青少年特发性脊柱侧凸 (AIS) 或成人脊柱畸形 (ASD) 而接受手术且至少有五个节段融合的患者的手术和麻醉数据。对 AIS、无椎弓根截骨术 (PSO) 的 ASD (ASD-PSO(-)) 和有 PSO 的 ASD (ASD-PSO(+)) 程序进行统计比较，以识别患者和/或手术-影响围手术期 BL 和 HBL 的相关因素。

结果

100 名患者平均有 9.9 ± 2.8 个椎骨融合，平均手术时间 (OT) 为 264.2 ± 68.3 分钟（每个级别 28.3 ± 9 分钟）。平均围手术期 BL 为 641.2 ± 313.8 ml（每个级别 68.9 ± 39.5 ml），平均 HBL 为 556.6 ± 381.8 ml（每个级别 60.6 ± 42.8 ml），后者占估计失血量 (EBL) 的 51.5% . 在多变量回归分析中，较长的 OT ( p  < 0.05; OR 3.38) 和执行 PSO ( p  < 0.05; OR 3.37) 与较高的围手术期 BL 相关，而年龄较大 ( p  < 0.05; OR 2.48) 和更高BMI ( p  < 0.05; OR 2.15) 与更显着的术后 HBL 相关。

结论

通过正确使用现代技术和患者管理，可以显着减少主要脊柱畸形手术中的 BL。然而，应该记住，50% 的患者估计损失是隐性的，无法直接控制。了解每个级别的 BL 可以预测全球损失，并可能预测同种异体输血的需要。