Intraoperative red blood cell salvage in posterior spinal fusions for idiopathic scoliosis: identifying potential criter
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Intraoperative red blood cell salvage in posterior spinal fusions for idiopathic scoliosis: identifying potential criteria for selective use Garrett E. Wahl1 · Scott J. Luhmann1 Received: 14 August 2020 / Accepted: 8 September 2020 © Scoliosis Research Society 2020
Abstract Study design Retrospective. Objectives Evaluate the role and effectiveness of ICS in primary posterior spinal fusion (PSF) for idiopathic scoliosis (IS). Summary of background data Intraoperative cell salvage (ICS) minimizes blood loss and need for allogeneic transfusions. However, it adds substantial charges ($800–1200 US) and may be of less clinical benefit in some PSF for IS. Materials and methods This was a single-hospital, retrospective analysis of 178 consecutive IS cases (10–18 years of age) who underwent primary PSF by a single pediatric spine surgeon. Results Overall, 41% of cases received a mean 167 cc of ICS blood, after a mean EBL of 528 mL (range 200–1800 mL). No blood was returned in 59% of cases, with a mean EBL of 293 mL (range 75–700 mL). Only 6.5% of the entire cohort received > / = 250 cc via ICS, after a mean EBL of 773 mL. A positive correlation exists between EBL and vertebral levels fused, preoperative major Cobb angle, and length of anesthesia (p / = 55°, anesthesia exposure > / = 6 h, and with use of posterior column osteotomies (PCOs) (p 375 mL to give 125 mL back to the patient. The transfusion of allogeneic blood was indicated in patients with hemodynamic lability and either higher absolute volume of blood loss or if there was ongoing blood loss. Several blood loss data points, radiographs, and TXA dosing measurements were missing from the available electronic health records for a small number of cases, which were therefore excluded in the corresponding statistical analyses. Patients were not excluded from the total 178 cases because of singular missing data points. Rather, all available data points were collected from these cases that had qualified for inclusion to obtain as much information for analysis as possible from the limited sample size. However, statistical analyses comparing specific data points did not include cases that were missing the necessary information. For instance, though data from 178 cases was utilized in the study, accurate information regarding Cell Saver return volume was not recovered for 9 patients. Analyses involving this data point were, therefore, calculated based on a sample size of 169. Other data points from these 9 cases were still utilized in separate analyses, as they provided valuable information regarding mean blood loss, surgical procedural data, and more that could be used in other clinical questions. Data were entered into the online project tool, Redcap, and exported to Excel for subsequent statistical analysis, including linear regression models, student’s unpaired t tests, and ANOVA analysis. The analyses were studied for patterns of statistical significance that may help determine when Cell
Saver is advisable to increase the likelihood of positive out
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