Guan Jian, Cole Chad D, Schmidt Meic H, Dailey Andrew T
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and.
Department of Neurosurgery, Westchester Medical Center, Valhalla, New York.
J Neurosurg Spine. 2017 Nov;27(5):528-533. doi: 10.3171/2017.5.SPINE1788. Epub 2017 Sep 1.
OBJECTIVE Blood loss during surgery for thoracolumbar scoliosis often requires blood product transfusion. Rotational thromboelastometry (ROTEM) has enabled the more targeted treatment of coagulopathy, but its use in deformity surgery has received limited study. The authors investigated whether the use of ROTEM reduces transfusion requirements in this case-control study of thoracolumbar deformity surgery. METHODS Data were prospectively collected on all patients who received ROTEM-guided blood product management during long-segment (≥ 7 levels) posterior thoracolumbar fusion procedures at a single institution from April 2015 to February 2016. Patients were matched with a group of historical controls who did not receive ROTEM-guided therapy according to age, fusion segments, number of osteotomies, and number of interbody fusion levels. Demographic, intraoperative, and postoperative transfusion requirements were collected on all patients. Univariate analysis of ROTEM status and multiple linear regression analysis of the factors associated with total in-hospital transfusion volume were performed, with p < 0.05 considered to indicate statistical significance. RESULTS Fifteen patients who received ROTEM-guided therapy were identified and matched with 15 non-ROTEM controls. The mean number of fusion levels was 11 among all patients, with no significant differences between groups in terms of fusion levels, osteotomy levels, interbody fusion levels, or other demographic factors. Patients in the non-ROTEM group required significantly more total blood products during their hospitalization than patients in the ROTEM group (8.5 ± 4.2 units vs 3.71 ± 2.8 units; p = 0.001). Multiple linear regression analysis showed that the use of ROTEM (p = 0.016) and a lower number of fused levels (p = 0.022) were associated with lower in-hospital transfusion volumes. CONCLUSIONS ROTEM use during thoracolumbar deformity correction is associated with lower transfusion requirements. Further investigation will better define the role of ROTEM in transfusion during deformity surgery.
目的 胸腰椎脊柱侧弯手术中的失血通常需要输注血液制品。旋转血栓弹力图（ROTEM）已使凝血病的治疗更具针对性，但其在畸形手术中的应用研究有限。在这项胸腰椎畸形手术的病例对照研究中，作者调查了使用ROTEM是否能减少输血需求。方法 前瞻性收集了2015年4月至2016年2月在单一机构接受长节段（≥7个节段）胸腰椎后路融合手术且采用ROTEM指导血液制品管理的所有患者的数据。根据年龄、融合节段、截骨数量和椎间融合节段数量，将患者与一组未接受ROTEM指导治疗的历史对照组进行匹配。收集所有患者的人口统计学、术中及术后输血需求数据。对ROTEM状态进行单因素分析，并对与住院期间总输血量相关的因素进行多元线性回归分析，p<0.05被认为具有统计学意义。结果 确定了15例接受ROTEM指导治疗的患者，并与15例非ROTEM对照组进行匹配。所有患者的平均融合节段数为11个，两组在融合节段、截骨节段、椎间融合节段或其他人口统计学因素方面无显著差异。非ROTEM组患者住院期间所需的总血液制品明显多于ROTEM组患者（8.5±4.2单位 vs 3.71±2.8单位；p = 0.001）。多元线性回归分析表明，使用ROTEM（p = 0.016）和较少的融合节段数（p = 0.022）与较低的住院输血量相关。结论 在胸腰椎畸形矫正手术中使用ROTEM与较低的输血需求相关。进一步的研究将更好地界定ROTEM在畸形手术输血中的作用。
