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Intraoperative Blood Loss at Different Surgical-Procedure Stages during Posterior Spinal Fusion for Idiopathic Scoliosis

Background and Objectives: Several predictive factors have been reportedly associated with intraoperative total blood loss (TBL) during posterior spinal fusion (PSF) for idiopathic scoliosis (IS). To reduce TBL, preoperative factors and interoperative factors are considered important. However, there...

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Autores principales: Shirasawa, Eiki, Saito, Wataru, Miyagi, Masayuki, Imura, Takayuki, Nakazawa, Toshiyuki, Mimura, Yusuke, Yokozeki, Yuji, Kuroda, Akiyoshi, Kawakubo, Ayumu, Uchida, Kentaro, Akazawa, Tsutomu, Takaso, Masashi, Inoue, Gen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9967596/
https://www.ncbi.nlm.nih.gov/pubmed/36837588
http://dx.doi.org/10.3390/medicina59020387
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author Shirasawa, Eiki
Saito, Wataru
Miyagi, Masayuki
Imura, Takayuki
Nakazawa, Toshiyuki
Mimura, Yusuke
Yokozeki, Yuji
Kuroda, Akiyoshi
Kawakubo, Ayumu
Uchida, Kentaro
Akazawa, Tsutomu
Takaso, Masashi
Inoue, Gen
author_facet Shirasawa, Eiki
Saito, Wataru
Miyagi, Masayuki
Imura, Takayuki
Nakazawa, Toshiyuki
Mimura, Yusuke
Yokozeki, Yuji
Kuroda, Akiyoshi
Kawakubo, Ayumu
Uchida, Kentaro
Akazawa, Tsutomu
Takaso, Masashi
Inoue, Gen
author_sort Shirasawa, Eiki
collection PubMed
description Background and Objectives: Several predictive factors have been reportedly associated with intraoperative total blood loss (TBL) during posterior spinal fusion (PSF) for idiopathic scoliosis (IS). To reduce TBL, preoperative factors and interoperative factors are considered important. However, there are few reports that have evaluated bleeding patterns according to surgical stages. This study aimed to elucidate bleeding patterns at different surgical stages and determine the predictive factors for TBL during PSF surgery in patients with IS. Materials and Methods: Preoperative data, radiographic parameters, and intraoperative data of patients undergoing PSF for IS were retrospectively collected. We divided the patients into six stages: stage 1, exposure; stage 2, implant placement; stage 3, release; stage 4, correction; stage 5, bone grafting; and stage 6, closure; then we reviewed the blood loss and bleeding speed. Multiple-regression analysis was performed to generate a predictive formula for blood loss using preoperative and intraoperative factors, including blood loss at stage 1, as explanatory variables. Results: Forty-five patients (mean age: 17.6 years) were included. The mean operative time and TBL were 287.9 min and 756.5 mL, respectively. Blood loss was the highest at stage 3, followed by stage 4. Bleeding speed was the highest at stage 4, followed by stage 3. Bleeding speeds at stages 3 and 4 were significantly higher than those at stages 1 and 2. Preoperative Cobb angle, activated partial thromboplastin time (aPTT), number of fused vertebrae, and blood loss at stage 1 were significant contributing factors. Conclusions: Blood loss and bleeding speed during the release and correction stages were high. Specifically, bleeding speed significantly increased during and after the release procedure. The preoperative Cobb angle, aPTT, number of fixed vertebrae, and blood-loss volume during PSF were significantly associated with TBL. Our findings would be helpful for reducing TBL in patients undergoing PSF for IS.
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spelling pubmed-99675962023-02-27 Intraoperative Blood Loss at Different Surgical-Procedure Stages during Posterior Spinal Fusion for Idiopathic Scoliosis Shirasawa, Eiki Saito, Wataru Miyagi, Masayuki Imura, Takayuki Nakazawa, Toshiyuki Mimura, Yusuke Yokozeki, Yuji Kuroda, Akiyoshi Kawakubo, Ayumu Uchida, Kentaro Akazawa, Tsutomu Takaso, Masashi Inoue, Gen Medicina (Kaunas) Article Background and Objectives: Several predictive factors have been reportedly associated with intraoperative total blood loss (TBL) during posterior spinal fusion (PSF) for idiopathic scoliosis (IS). To reduce TBL, preoperative factors and interoperative factors are considered important. However, there are few reports that have evaluated bleeding patterns according to surgical stages. This study aimed to elucidate bleeding patterns at different surgical stages and determine the predictive factors for TBL during PSF surgery in patients with IS. Materials and Methods: Preoperative data, radiographic parameters, and intraoperative data of patients undergoing PSF for IS were retrospectively collected. We divided the patients into six stages: stage 1, exposure; stage 2, implant placement; stage 3, release; stage 4, correction; stage 5, bone grafting; and stage 6, closure; then we reviewed the blood loss and bleeding speed. Multiple-regression analysis was performed to generate a predictive formula for blood loss using preoperative and intraoperative factors, including blood loss at stage 1, as explanatory variables. Results: Forty-five patients (mean age: 17.6 years) were included. The mean operative time and TBL were 287.9 min and 756.5 mL, respectively. Blood loss was the highest at stage 3, followed by stage 4. Bleeding speed was the highest at stage 4, followed by stage 3. Bleeding speeds at stages 3 and 4 were significantly higher than those at stages 1 and 2. Preoperative Cobb angle, activated partial thromboplastin time (aPTT), number of fused vertebrae, and blood loss at stage 1 were significant contributing factors. Conclusions: Blood loss and bleeding speed during the release and correction stages were high. Specifically, bleeding speed significantly increased during and after the release procedure. The preoperative Cobb angle, aPTT, number of fixed vertebrae, and blood-loss volume during PSF were significantly associated with TBL. Our findings would be helpful for reducing TBL in patients undergoing PSF for IS. MDPI 2023-02-16 /pmc/articles/PMC9967596/ /pubmed/36837588 http://dx.doi.org/10.3390/medicina59020387 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Shirasawa, Eiki
Saito, Wataru
Miyagi, Masayuki
Imura, Takayuki
Nakazawa, Toshiyuki
Mimura, Yusuke
Yokozeki, Yuji
Kuroda, Akiyoshi
Kawakubo, Ayumu
Uchida, Kentaro
Akazawa, Tsutomu
Takaso, Masashi
Inoue, Gen
Intraoperative Blood Loss at Different Surgical-Procedure Stages during Posterior Spinal Fusion for Idiopathic Scoliosis
title Intraoperative Blood Loss at Different Surgical-Procedure Stages during Posterior Spinal Fusion for Idiopathic Scoliosis
title_full Intraoperative Blood Loss at Different Surgical-Procedure Stages during Posterior Spinal Fusion for Idiopathic Scoliosis
title_fullStr Intraoperative Blood Loss at Different Surgical-Procedure Stages during Posterior Spinal Fusion for Idiopathic Scoliosis
title_full_unstemmed Intraoperative Blood Loss at Different Surgical-Procedure Stages during Posterior Spinal Fusion for Idiopathic Scoliosis
title_short Intraoperative Blood Loss at Different Surgical-Procedure Stages during Posterior Spinal Fusion for Idiopathic Scoliosis
title_sort intraoperative blood loss at different surgical-procedure stages during posterior spinal fusion for idiopathic scoliosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9967596/
https://www.ncbi.nlm.nih.gov/pubmed/36837588
http://dx.doi.org/10.3390/medicina59020387
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