Florida International University Herbert Wertheim College of Medicine, 11200 SW 8th Street, Miami, FL, 33199, USA.
Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA.
BMC Musculoskelet Disord. 2021 Feb 19;22(1):204. doi: 10.1186/s12891-021-04081-3.
Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah's witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion.
After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018. We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up).
Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (14), juvenile idiopathic (1), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.4° to 11.2° (80% correction, p < 0.001) at the latest follow-up. A mean of 11.4 levels were fused and 5.6 levels of Pontes osteotomies were performed. One patient underwent L1 hemivertebra resection and three patients had fusion to pelvis. Estimated blood loss, percent estimated blood volume loss, and cell saver returned averaged 307.9 mL, 8.5%, and 80 mL, respectively. Average operative time was 214 min. The average drop in hemoglobin after surgery was 2.9 g/dL. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative complications were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis.
Blood conservation techniques allow for safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications, when performed by an experienced multidisciplinary team.
Level IV.
小儿矫形外科传统上涉及大量失血。拒绝输血的患者会增加额外的临床和医学法律挑战；特别是耶和华见证会的人群。本研究的目的是回顾在拒绝输血的小儿脊柱畸形患者中，采用血液保护技术进行小儿脊柱畸形手术的安全性和有效性。
在获得机构审查委员会批准后，我们回顾性分析了 2014 年至 2018 年期间在一家机构接受脊柱畸形手术并拒绝输血的 20 例连续患者。我们收集了相关的术前、术中以及最近的临床和影像学数据，随访时间最短为 2 年。
确定了 20 例患者（13 例女性），平均年龄为 14.1 岁。脊柱畸形类型为青少年特发性脊柱侧凸（14 例）、青少年特发性脊柱侧凸（1 例）、神经肌肉型（3 例）和先天性脊柱侧凸（2 例）。在最近的随访中，主要冠状面 Cobb 角从 55.4°纠正至 11.2°（矫正 80%，p<0.001）。平均融合 11.4 个节段，行 5.6 个 Pontes 截骨术。1 例患者行 L1 半椎体切除术，3 例患者行骨盆融合术。估计失血量、估计失血量百分比和细胞回收器返回量分别为 307.9ml、8.5%和 80ml，平均手术时间为 214 分钟。术后血红蛋白平均下降 2.9g/dL。平均住院时间为 5.1 天。无术中并发症。术后出现 3 例并发症，均与拒绝输血无关。1 例患者住院期间发生呼吸并发症，1 例患者发生迟发性感染，1 例患者发生无症状的远端交界性后凸。
当由经验丰富的多学科团队进行操作时，血液保护技术可使拒绝输血的小儿患者安全有效地进行脊柱畸形手术，且无重大麻醉或医疗并发症。
IV 级。
