Pertes hématiques non détectées pendant la chirurgie de la scoliose - 27/09/22
Hidden blood loss in adolescent idiopathic scoliosis surgery
Abstract |
Introduction |
Posterior spinal fusions (PSF) for adolescent idiopathic scoliosis (AIS) have higher blood loss than other pediatric orthopedic surgeries. There is a paucity of literature estimating the hidden blood loss (HBL) in patients with AIS undergoing PSF. The purpose of this study was to compare intraoperative and postoperative estimated blood loss (EBL) in patients undergoing PSF for AIS to determine HBL.
Hypothesis |
With contemporary blood loss prevention strategies, HBL will be higher than intraoperative EBL.
Material and methods |
Over a 3-year period, 67 patients with preoperative and postoperative hemoglobin (Hgb) measurements undergoing PSF for AIS were evaluated. Intraoperative EBL was estimated using a volumetric method and recorded by a perfusionist managing a cell saver machine. Total perioperative EBL was estimated using the validated formula: EBL=weight (kg)×age sex factor×(preoperative Hgb−postoperative Hgb)/preoperative Hgb. HBL was calculated as the total perioperative EBL minus the intraoperative EBL.
Results |
Calculated total EBL was higher than intraoperative EBL (771±256mL vs. 110±115mL, p<0.001). Mean HBL after wound closure was 660±400mL. Patients 14 years or greater (p=0.03), with a BMI≥25kg/m2 (p=0.02) and with surgical times over 3.5 hours (p=0.05) had increased HBL. Multivariate analysis determined BMI≥25kg/m2 (OR 9.91; CI, 1.01–104.26; p=0.05) was associated with increased HBL. Allogenic blood transfusion was rare (4 %) and associated with increased HBL (897±112mL vs. 540±402mL, p=0.05).
Discussion |
For patients undergoing PSF for AIS there is more HBL after wound closure than intraoperative blood loss. This HBL is higher in older patients who undergo longer operations and have a BMI≥25kg/m2.
Level of evidence |
IV; retrospective cohort study.
Il testo completo di questo articolo è disponibile in PDF.Keywords : AIS, Blood loss, Complications, Transfusion
| ☆ | Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus. |
Vol 108 - N° 6
P. 779 - Ottobre 2022 Ritorno al numero
Articolo precedente
- Variations de l’équilibre sagittal de la colonne vertébrale après arthrodèse vertébrale postérieure, perte de correction et traitement par corset chez les adolescents avec une scoliose idiopathique
- Shu-Man Han, Jin-Xu Wen, Lei Cao, Hui-Zhao Wu, Chang Liu, Chen Yang, Hui-Hui Yang, Wen-Juan Wu, Bu-Lang Gao
- Résections vertébrales complètes par voie postérieure dans les déformations rachidiennes pédiatriques rigides
- Mourad Ould-Slimane, Mohammad Hossein Nabian, Anne-Laure Simon, Adèle Happiette, Florence Julien-Marsollier, Brice Ilharreborde
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