Alamanda Vignesh K, Massengill Danae L, Rozario Nigel, Moore Charity G, Scannell Brian, Brighton Brian, Vanderhave Kelly L
Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte.
School of Medicine, East Carolina University, Greenville.
Clin Spine Surg. 2018 Oct;31(8):E418-E421. doi: 10.1097/BSD.0000000000000689.
This was a retrospective cohort study.
The primary goal was to evaluate risk factors related to increased blood loss in adolescent idiopathic surgery (AIS) surgery with the secondary goal being to evaluate the financial implications around the use of intraoperative cell salvage (ICS) and the routine preallocation of autogenous blood products.
Deformity correction for AIS is a complex procedure and can be associated with significant blood loss.
A retrospective cohort study was conducted on consecutive patients between the ages of 10 and 18 years who underwent posterior spinal fusion of 7-12 levels over a 3-year period between January 2013 and December 2015. Demographic information and surgical characteristics were recorded. All patients had a preoperative type and cross of 2 units and ICS was used in all cases. Charges for preoperative type and cross and ICS were also measured. Univariate and multivariable analyses were performed to identify pertinent variables affecting blood loss.
In total, 134 patients met inclusion criteria. ICS was used in all cases. In total, 51 patients were transfused cell saver blood intraoperatively/postoperatively at the discretion of the surgeon. On average 133 mL were returned to the patient. No complications related to ICS were observed. Multivariable analysis identified male sex, lower body mass index and higher surgical time to be associated with increased blood loss (P<0.05). All 134 patients had a preoperative type and cross, with an average charge to patient of $311. Patients were charged $1037 for intraoperative use of ICS and $242 for centrifugation. Patients who had allogeneic transfusion were charged $1047.
Several blood conservation strategies, including use of ICS, exist to minimize the consequences of blood loss. Routine use of preoperative type and cross may be avoided except in cases where significant blood loss is anticipated-that is adolescent male individuals, those with a lower body mass index and in whom a longer surgical time is anticipated.
这是一项回顾性队列研究。
主要目标是评估青少年特发性脊柱侧弯（AIS）手术中与失血增加相关的危险因素，次要目标是评估术中细胞回收（ICS）的使用及自体血制品常规预分配的财务影响。
AIS的畸形矫正手术是一个复杂的过程，可能伴有大量失血。
对2013年1月至2015年12月期间连续接受7 - 12节段后路脊柱融合术的10至18岁患者进行回顾性队列研究。记录人口统计学信息和手术特征。所有患者术前均进行2单位血型鉴定和交叉配血，所有病例均使用ICS。还测量了术前血型鉴定和交叉配血以及ICS的费用。进行单因素和多因素分析以确定影响失血的相关变量。
共有134例患者符合纳入标准。所有病例均使用ICS。共有51例患者根据外科医生的判断在术中/术后输注了细胞回收血。平均有133毫升回输给患者。未观察到与ICS相关的并发症。多因素分析确定男性、较低的体重指数和较长的手术时间与失血增加相关（P<0.05）。所有134例患者均进行了术前血型鉴定和交叉配血，患者平均费用为311美元。患者术中使用ICS的费用为1037美元，离心费用为242美元。接受异体输血的患者费用为1047美元。
存在多种血液保护策略，包括使用ICS，以尽量减少失血的后果。除了预期有大量失血的情况（即青少年男性、体重指数较低且预期手术时间较长的患者）外，可避免常规进行术前血型鉴定和交叉配血。
