Boniello Anthony J, Verma Kushagra, Peters Austin, Lonner Baron S, Errico Thomas
Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY; Department of Orthopaedic Surgery, Drexel College of Medicine, Hahnemann University Hospital, Philadelphia, PA.
Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY; Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.
Int J Spine Surg. 2016 Aug 16;10:27. doi: 10.14444/3027. eCollection 2016.
Pre-donation of autologous blood prior to spine fusion for adolescent idiopathic scoliosis (AIS) has been used in deformity surgery. The effect of pre-donation on pre-operative hematocrit (Hct) remains debated. Multiple factors may influence pre-operative Hct including intravascular volume status, patient factors, and timing of pre-operative blood donation. The purpose of this study was to determine if pre-donation significantly lowers pre-incision Hct in AIS patients.
A retrospective cohort study of a Level-1 prospective randomized trial was conducted. 125 patients from the homogeneous population were included. AIS patients undergoing a posterior only spinal fusion for AIS were separated into two groups based on their pre-operative blood donation history. Demographic variables, pre-incision Hct, and transfusion rates were compared between the two groups using the Student's T-test.
Pre-donation and non pre-donation groups had 28 and 97 patients, respectively. Pre-donation group was 75% female (21F, 7M) and non pre-donation group was 78% female (76F, 21M). There was no difference between pre-donation and non pre-donation groups in mean age (15.6 ± 2.2 vs 14.8 ± 2.2, p = 0.081), BMI (23.1 ± 4.2 vs 21.7 ± 5.3, p = 0.219), and pre-incision Hct (32.8 ± 3.4 vs 33.8 ± 3.1, p = 0.628). The overall transfusion rates were equivalent (32.1± 48.0% vs 25.8 ± 44.0%, p = 0.509), however, the rate of allogenic transfusion for the pre-donation group was significantly lower (3.6 ± 18.9% vs 25.8 ± 44.0%, p = 0.011).
This study supports the use of pre-donation for AIS, without a significant drop in pre-incision Hct. Patients that donate are also much less likely to be exposed to allogenic blood. There may be a surgeon bias to recommend pre-donation in patients with a larger BMI and older age. Future studies are needed from a larger population of patients including those with non-AIS pathology.
Level III.
青少年特发性脊柱侧弯（AIS）脊柱融合术前自体血预存已应用于畸形手术中。预存对术前血细胞比容（Hct）的影响仍存在争议。多种因素可能影响术前Hct，包括血管内容量状态、患者因素以及术前献血时间。本研究的目的是确定预存是否会显著降低AIS患者术前切口时的Hct。
对一项一级前瞻性随机试验进行回顾性队列研究。纳入了125名来自同质人群的患者。接受单纯后路AIS脊柱融合术的AIS患者根据其术前献血史分为两组。使用学生t检验比较两组之间的人口统计学变量、术前切口时的Hct和输血率。
预存组和非预存组分别有28例和97例患者。预存组女性占75%（21名女性，7名男性），非预存组女性占78%（76名女性, 21名男性）。预存组和非预存组在平均年龄（15.6±2.2对14.8±2.2，p = 0.081）、体重指数（23.1±4.2对21.7±5.3，p = 0.219）和术前切口时的Hct（32.8±3.4对33.8±3.1，p = 0.628）方面没有差异。总体输血率相当（32.1±48.0%对25.8±44.0%，p = 0.509），然而，预存组的异体输血率显著更低（3.6±18.9%对25.8±44.0%，p = 0.011）。
本研究支持在AIS中使用预存，术前切口时的Hct不会显著下降。献血的患者也更不太可能接触异体血。对于体重指数较大和年龄较大的患者，外科医生可能存在推荐预存的偏倚。需要对更多患者群体进行进一步研究，包括患有非AIS病理情况的患者。
三级
