Team management in complex posterior spinal surgery allows blood loss limitation
Purpose The objective is to analyse peri-operative blood loss (BL) and hidden blood loss (HBL) rates in spinal deformity complex cases surgery, with a focus on the strategies to prevent major bleeding. Methods We retrospectively analysed surgical and anaesthesiologic data of patients who had been op...
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| Veröffentlicht in: | International orthopaedics 2023, Vol.47 (1), p.225-231 |
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| creator | Quarto, Emanuele Bourret, Stephane Rebollar, Yohann Mannem, Abhishek Cloche, Thibault Balabaud, Laurent Boue, Lisa Thompson, Wendy Le Huec, Jean-Charles |
| description | Purpose
The objective is to analyse peri-operative blood loss (BL) and hidden blood loss (HBL) rates in spinal deformity complex cases surgery, with a focus on the strategies to prevent major bleeding.
Methods
We retrospectively analysed surgical and anaesthesiologic data of patients who had been operated for adolescent idiopathic scoliosis (AIS) or adult spinal deformities (ASD) with a minimum of five levels fused. A statistical comparison among AIS, ASD without a pedicle subtraction osteotomy (PSO) (ASD-PSO( −)) and ASD with PSO (ASD-PSO( +)) procedures was performed with a view to identifying patient- and/or surgical-related factors affecting peri-operative BL and HBL.
Results
One-hundred patients were included with a mean 9.9 ± 2.8 fused vertebrae and a mean 264.2 ± 68.3 minutes operative time (OT) (28.3 ± 9 min per level). The mean perioperative BL was 641.2 ± 313.8 ml (68.9 ± 39.5 ml per level) and the mean HBL was 556.6 ± 381.8 ml (60.6 ± 42.8 ml per level), with the latter accounting for 51.5% of the estimated blood loss (EBL). On multivariate regression analysis, a longer OT (
p
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| doi_str_mv | 10.1007/s00264-022-05586-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2721262584</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2721262584</sourcerecordid><originalsourceid>FETCH-LOGICAL-c277t-ac6690561cfb4c0246fe165f280c39532059e8feaffca355327aff60cf7b9b583</originalsourceid><addsrcrecordid>eNp9kD1PwzAQhi0EoqXwBxiQRxaDP2InHlHFl1QJhjJbjmtXqZw42Img_x5DCiPTne6ee3V6ALgk-IZgXN4mjKkoEKYUYc4rgeQRmJOCUcSJ5MdgjllBEBWSz8BZSjuMSSkqcgpmTBBZ0KqYg9e11S1sdae3trXdAJsOmtD23n7CPqTBxiZEmPqm0x6mMW5t3EPtffhIsPYhbKAPKUHftM2ghyZ05-DEaZ_sxaEuwNvD_Xr5hFYvj8_LuxUytCwHpI0QEnNBjKsLg2khnCWCO1phwyRnFHNpK2e1c0YzngdlbgU2rqxlzSu2ANdTbh_D-2jToNomGeu97mwYk6IlJVRQXhUZpRNqYv41Wqf62LQ67hXB6tukmkyqbFL9mFQyH10d8se6tZu_k191GWATkPKqy17ULowxa0r_xX4BQpJ_nA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2721262584</pqid></control><display><type>article</type><title>Team management in complex posterior spinal surgery allows blood loss limitation</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Quarto, Emanuele ; Bourret, Stephane ; Rebollar, Yohann ; Mannem, Abhishek ; Cloche, Thibault ; Balabaud, Laurent ; Boue, Lisa ; Thompson, Wendy ; Le Huec, Jean-Charles</creator><creatorcontrib>Quarto, Emanuele ; Bourret, Stephane ; Rebollar, Yohann ; Mannem, Abhishek ; Cloche, Thibault ; Balabaud, Laurent ; Boue, Lisa ; Thompson, Wendy ; Le Huec, Jean-Charles</creatorcontrib><description>Purpose
The objective is to analyse peri-operative blood loss (BL) and hidden blood loss (HBL) rates in spinal deformity complex cases surgery, with a focus on the strategies to prevent major bleeding.
Methods
We retrospectively analysed surgical and anaesthesiologic data of patients who had been operated for adolescent idiopathic scoliosis (AIS) or adult spinal deformities (ASD) with a minimum of five levels fused. A statistical comparison among AIS, ASD without a pedicle subtraction osteotomy (PSO) (ASD-PSO( −)) and ASD with PSO (ASD-PSO( +)) procedures was performed with a view to identifying patient- and/or surgical-related factors affecting peri-operative BL and HBL.
Results
One-hundred patients were included with a mean 9.9 ± 2.8 fused vertebrae and a mean 264.2 ± 68.3 minutes operative time (OT) (28.3 ± 9 min per level). The mean perioperative BL was 641.2 ± 313.8 ml (68.9 ± 39.5 ml per level) and the mean HBL was 556.6 ± 381.8 ml (60.6 ± 42.8 ml per level), with the latter accounting for 51.5% of the estimated blood loss (EBL). On multivariate regression analysis, a longer OT (
p
< 0.05; OR 3.38) and performing a PSO (
p
< 0.05; OR 3.37) were related to higher peri-operative BL, while older age (
p
< 0.05; OR 2.48) and higher BMI (
p
< 0.05; OR 2.15) were associated to a more significant post-operative HBL.
Conclusion
With the correct use of modern technologies and patient management, BL in major spinal deformity surgery can be dramatically reduced. Nevertheless, it should be kept in mind that 50% of patients estimated losses are hidden and not directly controllable. Knowing the per-level BL allows anticipating global losses and, possibly, the need of allogenic transfusions.</description><identifier>ISSN: 0341-2695</identifier><identifier>EISSN: 1432-5195</identifier><identifier>DOI: 10.1007/s00264-022-05586-9</identifier><identifier>PMID: 36194284</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adult ; Blood Loss, Surgical - prevention & control ; Humans ; Kyphosis - surgery ; Medicine ; Medicine & Public Health ; Original Paper ; Orthopedics ; Osteotomy - adverse effects ; Osteotomy - methods ; Retrospective Studies ; Scoliosis - surgery ; Spinal Fusion - adverse effects ; Spinal Fusion - methods ; Treatment Outcome</subject><ispartof>International orthopaedics, 2023, Vol.47 (1), p.225-231</ispartof><rights>The Author(s) under exclusive licence to SICOT aisbl 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. The Author(s) under exclusive licence to SICOT aisbl.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c277t-ac6690561cfb4c0246fe165f280c39532059e8feaffca355327aff60cf7b9b583</citedby><cites>FETCH-LOGICAL-c277t-ac6690561cfb4c0246fe165f280c39532059e8feaffca355327aff60cf7b9b583</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00264-022-05586-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00264-022-05586-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36194284$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Quarto, Emanuele</creatorcontrib><creatorcontrib>Bourret, Stephane</creatorcontrib><creatorcontrib>Rebollar, Yohann</creatorcontrib><creatorcontrib>Mannem, Abhishek</creatorcontrib><creatorcontrib>Cloche, Thibault</creatorcontrib><creatorcontrib>Balabaud, Laurent</creatorcontrib><creatorcontrib>Boue, Lisa</creatorcontrib><creatorcontrib>Thompson, Wendy</creatorcontrib><creatorcontrib>Le Huec, Jean-Charles</creatorcontrib><title>Team management in complex posterior spinal surgery allows blood loss limitation</title><title>International orthopaedics</title><addtitle>International Orthopaedics (SICOT)</addtitle><addtitle>Int Orthop</addtitle><description>Purpose
The objective is to analyse peri-operative blood loss (BL) and hidden blood loss (HBL) rates in spinal deformity complex cases surgery, with a focus on the strategies to prevent major bleeding.
Methods
We retrospectively analysed surgical and anaesthesiologic data of patients who had been operated for adolescent idiopathic scoliosis (AIS) or adult spinal deformities (ASD) with a minimum of five levels fused. A statistical comparison among AIS, ASD without a pedicle subtraction osteotomy (PSO) (ASD-PSO( −)) and ASD with PSO (ASD-PSO( +)) procedures was performed with a view to identifying patient- and/or surgical-related factors affecting peri-operative BL and HBL.
Results
One-hundred patients were included with a mean 9.9 ± 2.8 fused vertebrae and a mean 264.2 ± 68.3 minutes operative time (OT) (28.3 ± 9 min per level). The mean perioperative BL was 641.2 ± 313.8 ml (68.9 ± 39.5 ml per level) and the mean HBL was 556.6 ± 381.8 ml (60.6 ± 42.8 ml per level), with the latter accounting for 51.5% of the estimated blood loss (EBL). On multivariate regression analysis, a longer OT (
p
< 0.05; OR 3.38) and performing a PSO (
p
< 0.05; OR 3.37) were related to higher peri-operative BL, while older age (
p
< 0.05; OR 2.48) and higher BMI (
p
< 0.05; OR 2.15) were associated to a more significant post-operative HBL.
Conclusion
With the correct use of modern technologies and patient management, BL in major spinal deformity surgery can be dramatically reduced. Nevertheless, it should be kept in mind that 50% of patients estimated losses are hidden and not directly controllable. Knowing the per-level BL allows anticipating global losses and, possibly, the need of allogenic transfusions.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Blood Loss, Surgical - prevention & control</subject><subject>Humans</subject><subject>Kyphosis - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Paper</subject><subject>Orthopedics</subject><subject>Osteotomy - adverse effects</subject><subject>Osteotomy - methods</subject><subject>Retrospective Studies</subject><subject>Scoliosis - surgery</subject><subject>Spinal Fusion - adverse effects</subject><subject>Spinal Fusion - methods</subject><subject>Treatment Outcome</subject><issn>0341-2695</issn><issn>1432-5195</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD1PwzAQhi0EoqXwBxiQRxaDP2InHlHFl1QJhjJbjmtXqZw42Img_x5DCiPTne6ee3V6ALgk-IZgXN4mjKkoEKYUYc4rgeQRmJOCUcSJ5MdgjllBEBWSz8BZSjuMSSkqcgpmTBBZ0KqYg9e11S1sdae3trXdAJsOmtD23n7CPqTBxiZEmPqm0x6mMW5t3EPtffhIsPYhbKAPKUHftM2ghyZ05-DEaZ_sxaEuwNvD_Xr5hFYvj8_LuxUytCwHpI0QEnNBjKsLg2khnCWCO1phwyRnFHNpK2e1c0YzngdlbgU2rqxlzSu2ANdTbh_D-2jToNomGeu97mwYk6IlJVRQXhUZpRNqYv41Wqf62LQ67hXB6tukmkyqbFL9mFQyH10d8se6tZu_k191GWATkPKqy17ULowxa0r_xX4BQpJ_nA</recordid><startdate>2023</startdate><enddate>2023</enddate><creator>Quarto, Emanuele</creator><creator>Bourret, Stephane</creator><creator>Rebollar, Yohann</creator><creator>Mannem, Abhishek</creator><creator>Cloche, Thibault</creator><creator>Balabaud, Laurent</creator><creator>Boue, Lisa</creator><creator>Thompson, Wendy</creator><creator>Le Huec, Jean-Charles</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2023</creationdate><title>Team management in complex posterior spinal surgery allows blood loss limitation</title><author>Quarto, Emanuele ; Bourret, Stephane ; Rebollar, Yohann ; Mannem, Abhishek ; Cloche, Thibault ; Balabaud, Laurent ; Boue, Lisa ; Thompson, Wendy ; Le Huec, Jean-Charles</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c277t-ac6690561cfb4c0246fe165f280c39532059e8feaffca355327aff60cf7b9b583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Blood Loss, Surgical - prevention & control</topic><topic>Humans</topic><topic>Kyphosis - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Paper</topic><topic>Orthopedics</topic><topic>Osteotomy - adverse effects</topic><topic>Osteotomy - methods</topic><topic>Retrospective Studies</topic><topic>Scoliosis - surgery</topic><topic>Spinal Fusion - adverse effects</topic><topic>Spinal Fusion - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Quarto, Emanuele</creatorcontrib><creatorcontrib>Bourret, Stephane</creatorcontrib><creatorcontrib>Rebollar, Yohann</creatorcontrib><creatorcontrib>Mannem, Abhishek</creatorcontrib><creatorcontrib>Cloche, Thibault</creatorcontrib><creatorcontrib>Balabaud, Laurent</creatorcontrib><creatorcontrib>Boue, Lisa</creatorcontrib><creatorcontrib>Thompson, Wendy</creatorcontrib><creatorcontrib>Le Huec, Jean-Charles</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Quarto, Emanuele</au><au>Bourret, Stephane</au><au>Rebollar, Yohann</au><au>Mannem, Abhishek</au><au>Cloche, Thibault</au><au>Balabaud, Laurent</au><au>Boue, Lisa</au><au>Thompson, Wendy</au><au>Le Huec, Jean-Charles</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Team management in complex posterior spinal surgery allows blood loss limitation</atitle><jtitle>International orthopaedics</jtitle><stitle>International Orthopaedics (SICOT)</stitle><addtitle>Int Orthop</addtitle><date>2023</date><risdate>2023</risdate><volume>47</volume><issue>1</issue><spage>225</spage><epage>231</epage><pages>225-231</pages><issn>0341-2695</issn><eissn>1432-5195</eissn><abstract>Purpose
The objective is to analyse peri-operative blood loss (BL) and hidden blood loss (HBL) rates in spinal deformity complex cases surgery, with a focus on the strategies to prevent major bleeding.
Methods
We retrospectively analysed surgical and anaesthesiologic data of patients who had been operated for adolescent idiopathic scoliosis (AIS) or adult spinal deformities (ASD) with a minimum of five levels fused. A statistical comparison among AIS, ASD without a pedicle subtraction osteotomy (PSO) (ASD-PSO( −)) and ASD with PSO (ASD-PSO( +)) procedures was performed with a view to identifying patient- and/or surgical-related factors affecting peri-operative BL and HBL.
Results
One-hundred patients were included with a mean 9.9 ± 2.8 fused vertebrae and a mean 264.2 ± 68.3 minutes operative time (OT) (28.3 ± 9 min per level). The mean perioperative BL was 641.2 ± 313.8 ml (68.9 ± 39.5 ml per level) and the mean HBL was 556.6 ± 381.8 ml (60.6 ± 42.8 ml per level), with the latter accounting for 51.5% of the estimated blood loss (EBL). On multivariate regression analysis, a longer OT (
p
< 0.05; OR 3.38) and performing a PSO (
p
< 0.05; OR 3.37) were related to higher peri-operative BL, while older age (
p
< 0.05; OR 2.48) and higher BMI (
p
< 0.05; OR 2.15) were associated to a more significant post-operative HBL.
Conclusion
With the correct use of modern technologies and patient management, BL in major spinal deformity surgery can be dramatically reduced. Nevertheless, it should be kept in mind that 50% of patients estimated losses are hidden and not directly controllable. Knowing the per-level BL allows anticipating global losses and, possibly, the need of allogenic transfusions.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>36194284</pmid><doi>10.1007/s00264-022-05586-9</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adolescent Adult Blood Loss, Surgical - prevention & control Humans Kyphosis - surgery Medicine Medicine & Public Health Original Paper Orthopedics Osteotomy - adverse effects Osteotomy - methods Retrospective Studies Scoliosis - surgery Spinal Fusion - adverse effects Spinal Fusion - methods Treatment Outcome |
| title | Team management in complex posterior spinal surgery allows blood loss limitation |
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