Abstract
Background: Anterior scoliosis surgery is associated with potentially significant intra-operative blood loss, requiring homologous transfusion either intra- or postoperatively. Blood loss in this type of surgery correlates with surgical & anaesthetic techniques. In our centre the development of specific anaesthetic techniques as well as the routine use of Cell Salvage has dramatically reduced the rates of homologous blood transfusion. Currently, specific indications for the use of the Cell Saver in Anterior Scoliosis Surgery have not been proven. Previous studies have commented on the beneficial aspects of autologous transfusion for Orthopaedic patients in general; However, others have shown a negligible advantage specifically in anterior thoracolumbar fusion surgery. The aim of our study was to assess and quantify the use of homologous blood, as well as the effects on haematological indices.
Methods: We carried out a retrospective study of 144 consecutive patients, all of whom underwent instrumented anterior scoliosis correction between April 2001 and October 2004. A cell saver was used in all the cases, and hospital data (including haematological indices and number of levels fused) was collected.
Results: The median age of the study cohort was 15.0 years (range 8 – 46), and there were 31 males and 113 females. The mean preoperative haemoglobin in patients was 13.5g/dl and the mean postoperative haemoglobin was 10.6g/dl. Haematocrit values followed a similar pattern, the mean pre-op value being 0.41, mean post-op value was 0.29. The range of volume of intra-operatively salvaged cells was 200 to 1100mls. 25 of 144 patients required transfusion. In these patients, the average number of units given was 2.3, although the total homologous transfusion rate was 0.4 units per patient. Results show that homologous transfusion was not required in 82.6% of patients. This is better than previously published rates of transfusion in this procedure. There was no correlation between the number of levels instrumented and the number of units transfused (Pearson Correlation Coefficient 0.19), and no correlation between the number of levels instrumented and postoperative haematocrit values (Pearson Correlation Coefficient 0.16). None of the patients required intra-operative homologous transfusion.
Conclusion: Our experience shows that along with meticulous surgical haemostasis, and hypotensive anaesthesia the use of Salvaged Autologous Blood Transfusion in anterior scoliosis surgery has an important role in reducing the incidence of postoperative anaemia and homologous transfusion requirements.
The abstracts were prepared by Mr Colin E. Bruce. Correspondence should be addressed to Colin E. Bruce, Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Eaton Road, Liverpool, L12 2AP.
