A study presented at the 19th International Meeting on Advanced Spine Techniques (IMAST; 18-21 July, Istanbul, Turkey) indicates that patient diagnosis has a significant influence on the amount of blood loss during posterior spinal fusion surgery
Study presenter Paul Sponseller, chief, Division of Pediatric Orthopaedics, Johns Hopkins Children’s Centre, Baltimore, USA, explained that posterior spinal fusion for correcting paediatric spinal deformity often involved substantial blood loss and said: “Understanding factors associated with increased intra-operative blood loss can help the surgical team, including the anaesthesiologist, to plan.” Thus the aim of their study was to “look at the relationship between patient diagnosis and blood loss in children undergoing posterior spinal fusion.”
The investigators, the lead author of which was Amit Jain (Johns Hopkins Children’s Centre, Baltimore, USA), reviewed clinical records for all patients aged between 10 and 18 who had undergone spinal fusion surgery between 2001 and 2011 at the investigators’ institute (Johns Hopkins Children’s Centre). After excluding patients who did not meet the inclusion criteria (eg, received antifibrinolytics), 617 patient records were available for analysis. Sponseller said: “These patients were divided into five groups: idiopathic scoliosis, Scheuermann’s kyphosis, cerebral palsy, other neuromuscular diseases, and genetic and syndromic disorders.”
He added that the estimated blood loss did differ significantly by diagnostic group, with the lowest estimated blood loss found in patients with Scheuermann’s kyphosis and the highest estimated blood loss found in patients with cerebral palsy. Also, patients with cerebral palsy had significantly higher normalised blood loss (estimated blood loss after adjusting for patient weight and number of levels fused) in comparison with all of the other groups: idiopathic scoliosis (p<0.001); Scheuermann’s kyphosis (p<0.001), other neuromuscular disorders (p=0.049); and genetic and syndromic disorders (p=0.006).
Sponseller said: “Patients with other neuromuscular disorders also had higher normalised blood loss, but it was only significantly higher compared with patients with idiopathic scoliosis or Scheuermann’s kyphosis (p<0.001 for all comparisons).” Patients with genetic or syndromic disorders had significantly higher normalised blood loss than patients with idiopathic scoliosis or Scheuermann’s kyphosis (p<0.001) as well, but there were no significant differences between patients with other neuromuscular disorders and genetic syndromic disorders nor were there any significant differences between patients with idiopathic scoliosis and those with Scheuermann’s kyphosis.
Sponseller concluded: “Diagnosis, after adjusting for extent of fusion and weight, is significantly related to estimated blood loss during posterior spinal fusion. Paediatric patients with cerebral palsy have significantly more normalised blood loss than all other diagnoses.” He added that tissue and systemic haemostatic factors may be responsible.