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Team management in complex posterior spinal surgery allows blood loss limitation

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Abstract

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.

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Data availability

Underlying data can be requested by email directly to the corresponding author.

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Authors and Affiliations

  1. IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy

    Emanuele Quarto

  2. Polyclinique Bordeaux Nord Aquitaine, Vertebra, 15 Rue Boucher, 33300, Bordeaux, France

    Stephane Bourret, Yohann Rebollar, Abhishek Mannem, Thibault Cloche, Laurent Balabaud, Lisa Boue, Wendy Thompson & Jean-Charles Le Huec

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  1. Emanuele Quarto
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  2. Stephane Bourret
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  3. Yohann Rebollar
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  4. Abhishek Mannem
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  5. Thibault Cloche
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  6. Laurent Balabaud
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  7. Lisa Boue
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  8. Wendy Thompson
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  9. Jean-Charles Le Huec
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Contributions

Data collection and analysis: Emanuele Quarto, Yohann Rebollar, Abhishek Mannem, Thibault Cloche, Laurent Balabaud and Wendy Thompson. Article first writing: Emanuele Quarto and Stephane Bourret. Statistical analysis: Staphane Bourret and Lisa Boue. Corrections, revisions and final approval: Jean-Charles Le Huec.

Corresponding author

Correspondence to Jean-Charles Le Huec.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. The approval was granted by the Ethics Committee of SFCR (Societé Francaise de Chirurgie Rachidienne) (10 December 2022, N° 2020-A1202).

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All patients were approved for treatment by written informed consent.

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All patients signed in an informed consent for publication.

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The authors declare no competing interests.

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Quarto, E., Bourret, S., Rebollar, Y. et al. Team management in complex posterior spinal surgery allows blood loss limitation. International Orthopaedics (SICOT) 47, 225–231 (2023). https://doi.org/10.1007/s00264-022-05586-9

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  • DOI: https://doi.org/10.1007/s00264-022-05586-9

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