Asma Ali, Gajewski Nicholas, Shah Suken A, Ulusaloglu Armagan Can, Kraft Denver B, Yorgova Petya K, Sponseller Paul D, Jain Amit, Yaszay Burt, Samdani Amer F, Miyanji Firoz
Department of Orthopaedics, Nemours Children's Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE, 19803, USA.
Johns Hopkins Medicine, Baltimore, MA, USA.
Spine Deform. 2025 May 11. doi: 10.1007/s43390-025-01091-2.
This article aimed to determine modifiable risk factors to prevent massive blood transfusion of blood products (MTBP) during spinal fusion in patients with cerebral palsy.
Patient data were queried from a prospectively collected multicenter database. Perioperative MTBP was defined as the administration of allogenic blood products equaling at least half (50%) of the patients' preoperative blood volume during the surgical procedure. Univariate and multivariate logistic regression was used for statistical analysis.
Three hundred thirty-three patients were included. Ninety-four percent of patients were Gross Motor Classification System IV and V. The incidence of MTBP was 29.7% (99/333). The lack of antifibrinolytic use was significant at univariate analysis. Preoperative low weight, blood volume loss, hybrid system, and unit rod use remained significant after the adjustment in multivariate analysis. Loss of more than 68% of patient blood volume was the threshold for MTBP. Patients receiving MTBP had increased hospital (P = 0.006) and intensive care unit (P < 0.001) stays. However, surgical site complications, deep wound infections, and reoperation rate were not different (P = 0.12, P = 0.46, P = 0.22, respectively). There was a significant decrease in MTBP incidence from 2008 (53%) to 2016 (11%) (P < 0.001) with routine administration of antifibrinolytics.
The incidence of MTBP in patients with cerebral palsy undergoing PSF during the study period was 29.7% and this rate has decreased over time, making the surgery safer. Optimization of preoperative nutrition status, use of pedicle screw constructs when possible, and use of antifibrinolytics when not contraindicated is recommended to reduce the risk of perioperative MTBP.
Level III-Retrospective cohort study.
本文旨在确定可改变的风险因素，以预防脑瘫患者脊柱融合术中大量输血（MTBP）。
从前瞻性收集的多中心数据库中查询患者数据。围手术期MTBP定义为手术过程中输注的异体血制品量至少等于患者术前血容量的一半（50%）。采用单因素和多因素逻辑回归进行统计分析。
共纳入333例患者。94%的患者为粗大运动功能分级系统IV级和V级。MTBP的发生率为29.7%（99/333）。单因素分析显示未使用抗纤溶药物具有显著意义。多因素分析调整后，术前体重低、血容量丢失、混合系统和使用单棒仍具有显著意义。患者血容量丢失超过68%是MTBP的阈值。接受MTBP的患者住院时间（P = 0.006）和重症监护病房停留时间（P < 0.001）增加。然而，手术部位并发症、深部伤口感染和再次手术率无差异（分别为P = 0.12、P = 0.46、P = 0.22）。随着抗纤溶药物的常规使用，MTBP发生率从2008年的53%显著下降至2016年（11%）（P < 0.001）。
在研究期间，接受后路脊柱融合术的脑瘫患者中MTBP的发生率为29.7%，且该发生率随时间下降，使手术更安全。建议优化术前营养状况，尽可能使用椎弓根螺钉结构，在无禁忌证时使用抗纤溶药物，以降低围手术期MTBP的风险。
III级——回顾性队列研究。
